Renal-homing peptide conjugates and methods of use thereof

ABSTRACT

Peptides that home, target, migrate to, are directed to, are retained by, or accumulate in and/or bind to the kidney of a subject are disclosed. Pharmaceutical compositions and uses for peptides or peptide-active agent complexes comprising such peptide-active agent conjugates are also disclosed. Such compositions can be formulated for targeted delivery of an active agent to a target region, tissue, structure or cell in the kidney. Targeted compositions of the disclosure can deliver peptide or peptide-active agent complexes to targe regions, tissues, structures, or cells targeted by the peptide.

CROSS REFERENCE

This application is a U.S. National Phase Application under 35 U.S.C. § 371 of International Application No. PCT/US2018/037544, filed Jun. 14, 2018, which claims the benefit of U.S. Provisional Patent Application No. 62/520,323, filed Jun. 15, 2017, the entire disclosures of which are incorporated by reference.

SEQUENCE LISTING

The instant application contains a Sequence Listing which has been submitted electronically in ASCII format and is hereby incorporated by reference in its entirety. Said ASCII copy, created on Jun. 29, 2018, is named 45639-712 601 SL.txt and is 380,367 bytes in size.

BACKGROUND

Approximately 9% of the world's population either has, or is expected to develop, chronic renal disease. The leading causes in the United States are diabetic nephropathy and progressive renal dysfunction following a bout of ischemic (e.g., post-cardiac surgery) or toxin-induced (e.g., radiocontrast media, cancer chemotherapy) kidney proximal tubule damage. At present, the US End Stage Renal Disease (ESRD) program consumes ˜7% of the entire Medicare budget. Furthermore, even modest declines in renal function can represent progressive, independent risk factors for rising hospital expenditures, morbidity and mortality. Thus, new ways to protect kidneys, and prophylactically prevent and treat progressive renal diseases are needed.

SUMMARY

The present disclosure relates to compositions and methods for treatment of renal disorders. Described herein are peptides that home to, migrate to, accumulate in, bind to, are retained by, or are directed to, and/or bind in kidney following administration in a subject. In some embodiments, the homing peptides of the present disclosure are used to deliver a detection agent to image and/or diagnose renal injury, or disease. In other embodiments, the homing peptides of the present disclosure are used to treat or deliver an active agent to a region, tissue, structure, or cell thereof.

In some aspects, a peptide active agent conjugate comprises a) a peptide, wherein the peptide comprises a sequence that has at least 70% sequence identity with any one of SEQ ID NO: 236-SEQ ID NO: 276, wherein upon administration to a subject the peptide homes, targets, migrates to, accumulates in, binds to, is retained by, or is directed to a kidney of the subject; and an active agent selected from an active agent class selected from TABLE 5 or TABLE 6; b) a peptide, wherein the peptide comprises a sequence that has at least 70% sequence identity with any one of SEQ ID NO: 1-SEQ ID NO: 41, wherein upon administration to a subject the peptide homes, targets, migrates to, accumulates in, binds to, is retained by, or is directed to a kidney of the subject; and an active agent selected from TABLE 5 or TABLE 6; c) a peptide, wherein the peptide comprises a sequence that has at least 70% sequence identity with any one of SEQ ID NO: 471-SEQ ID NO: 529, wherein upon administration to a subject the peptide homes, targets, migrates to, accumulates in, binds to, is retained by, or is directed to a kidney of the subject; and an active agent selected from an active agent class selected from TABLE 5 or TABLE 6; d) a peptide, wherein the peptide comprises a sequence that has at least 70% sequence identity with any one of SEQ ID NO: 277-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 470, wherein upon administration to a subject the peptide homes, targets, migrates to, accumulates in, binds to, is retained by, or is directed to a kidney of the subject; and an active agent selected from an active agent class selected from TABLE 6; or e) a peptide, wherein the peptide comprises a sequence that has at least 70% sequence identity with any one of SEQ ID NO: 42-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, or SEQ ID NO: 216-SEQ ID NO: 235, wherein upon administration to a subject the peptide homes, targets, migrates to, accumulates in, binds to, is retained by, or is directed to a kidney of the subject; and an active agent selected from an active agent class selected from TABLE 6. In various aspects, the active agent is selected from TABLE 5.

In some aspects, the peptide active agent conjugate homes, targets, migrates to, accumulates in, binds to, is retained by, or is directed to a kidney of the subject. In other aspects, the peptide homes, targets, migrates to, accumulates in, binds to, is retained by, or is directed to proximal tubules of the kidney.

In various aspects, the peptide comprises: a) a sequence that has at least 75%, at least 80%, at least 85%, at least 90%, or at least 95%, at least 97%, at least 99% or 100% sequence identity with any one of SEQ ID NO: 236-SEQ ID NO: 276, or a fragment thereof; b) a sequence that has at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 97%, at least 99%, or 100% sequence identity with any one of SEQ ID NO: 1-SEQ ID NO: 41 or a fragment thereof; c) a sequence that has at least 75%, at least 80%, at least 85%, at least 90%, or at least 95%, at least 97%, at least 99% or 100% sequence identity with any one of SEQ ID NO: 471-SEQ ID NO: 529 or a fragment thereof; d) a sequence that has at least 75%, at least 80%, at least 85%, at least 90%, or at least 95%, at least 97%, at least 99% or 100% sequence identity with any one of SEQ ID NO: 277-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 470 or a fragment thereof; or e) a sequence that has at least 75%, at least 80%, at least 85%, at least 90%, or at least 95%, at least 97%, at least 99% or 100% sequence identity with any one of SEQ ID NO: 42-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, or SEQ ID NO: 216-SEQ ID NO: 235 or a fragment thereof. In other aspects, the peptide comprises: a) a sequence of any one of SEQ ID NO: 236-SEQ ID NO: 276 or a fragment thereof; b) a sequence of any one of SEQ ID NO: 1-SEQ ID NO: 41 or a fragment thereof; c) a sequence of any one of SEQ ID NO: 471-SEQ ID NO: 529 or a fragment thereof; d) a sequence of any one of SEQ ID NO: 277-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 470 or a fragment thereof; or e) a sequence of any one of SEQ ID NO: 42-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, or SEQ ID NO: 216-SEQ ID NO: 235 or a fragment thereof. In various aspects, the peptide comprises a) a sequence of any one of SEQ ID NO: 550-SEQ ID NO: 569 or a fragment thereof; or b) a sequence of any one of SEQ ID NO: 530-SEQ ID NO: 549 or SEQ ID NO: 570, or a fragment thereof.

In some aspects, the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 99%, or 100% identical to SEQ ID NO: 135. In some aspects, the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 99%, or 100% identical to SEQ ID NO: 42. In other aspects, the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 99%, or 100% identical to SEQ ID NO: 45. In still other aspects, the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 99%, or 100% identical to SEQ ID NO: 217. In some aspects, the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 99%, or 100% identical to SEQ ID NO: 48. In some aspects, the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 99%, or 100% identical to SEQ ID NO: 132. In other aspects, the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 99%, or 100% identical to SEQ ID NO: 54. In some aspects, the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 99%, or 100% identical to SEQ ID NO: 231. In some aspects, the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 99%, or 100% identical to SEQ ID NO: 43. In other aspects, the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 99%, or 100% identical to SEQ ID NO: 130. In some aspects, the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 99%, or 100% identical to SEQ ID NO: 44. In some aspects, the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 99%, or 100% identical to SEQ ID NO: 219. In some aspects, the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 99%, or 100% identical to SEQ ID NO: 131. In some aspects, the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 99%, or 100% identical to SEQ ID NO: 33. In other aspects, the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 99%, or 100% identical to SEQ ID NO: 4. In some aspects, the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 99%, or 100% identical to SEQ ID NO: 41. In some aspects the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 99%, or 100% identical to SEQ ID NO: 5. In some aspects, the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 99%, or 100% identical to SEQ ID NO: 6. In other aspects, the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 99%, or 100% identical to SEQ ID NO: 196.

In some aspects, the peptide is covalently conjugated to the active agent. In some aspects, the peptide active agent conjugate homes, targets, migrates to, accumulates in, binds to, is retained by, or is directed to a kidney of the subject. In some aspects, the peptide comprises 4 or more cysteine residues. In further aspects, the peptide comprises three or more disulfide bridges formed between cysteine residues, wherein one of the disulfide bridges passes through a loop formed by two other disulfide bridges. In some aspects, the peptide comprises a plurality of disulfide bridges formed between cysteine residues. In some aspects, the peptide comprises a disulfide through a disulfide knot.

In some aspects, at least one amino acid residue of the peptide is in an L configuration or, wherein at least one amino acid residue of the peptide is in a D configuration. In some aspects, the sequence comprises at least 11, at least 12, at least 13, at least 14, at least 15, at least 16, at least 17, at least 18, at least 19, at least 20, at least 21, at least 22, at least 23, at least 24, at least 25, at least 26, at least 27, at least 28, at least 29, at least 30, at least 31, at least 32, at least 33, at least 34, at least 35, at least 36, at least 37, at least 38, at least 39, at least 40, at least 41, at least 42, at least 43, at least 44, at least 45, at least 46, at least 47, at least 48, at least 49, at least 50, at least 51, at least 52, at least 53, at least 54, at least 55, at least 56, at least 57, at least 58 residues, at least 59, at least 60, at least 61, at least 62, at least 63, at least 64, at least 65, at least 66, at least 67, at least 68, at least 69, at least 70, at least 71, at least 72, at least 73, at least 74, at least 75, at least 76, at least 77, at least 78, at least 79, at least 80, or at least 81 residues.

In some aspects, any one or more K residues are replaced by an A or R residue or wherein any one or more A or R residues are replaced by for a K residue. In some aspects, any one or more M residues are replaced by any one of the I, L, or V residues. In some aspects, any one or more L residues are replaced by any one of the V, I, or M residues. In some aspects, any one or more I residues are replaced by any of the M, L, or V residues.

In other aspects, any one or more V residues are replaced by any of the M, I, or L residues. In still other aspects, any one or more G residues are replaced by an A residue or wherein any one or more A residues are replaced by a G residue. In some aspects, any one or more S residues are replaced by a T residue or wherein any one or more T residues are replaced by for an S residue. In some aspects, any one or more Q residues are replaced by an N residue or wherein any one or more N residues are replaced by a Q residue. In some aspects, any one or more D residues are replaced by an E residue or wherein any one or more E residues are replaced by a D residue.

In some aspects, the peptide has a charge distribution comprising an acidic region and a basic region. In further aspects, the acidic region is a nub. In other aspects, the basic region is a patch. In some aspects, the peptide comprises 5-12 basic residues. In some aspects, the peptide comprises 0-5 acidic residues. In some aspects, the peptide comprises 6 or more basic residues and 2 or fewer acidic residues. In some aspects, the peptide comprises a 4-19 amino acid residue fragment containing at least 2 cysteine residues, and at least 2 positively charged amino acid residues.

In other aspects, the peptide comprises a 20-70 amino acid residue fragment containing at least 2 cysteine residues, no more than 2 basic residues and at least 2 positively charged amino acid residues. In still other aspects, the peptide comprises at least 3 positively charged amino acid residues. In some aspects, the positively charged amino acid residues are selected from K, R, or a combination thereof.

In some aspects, the peptide has a charge greater than 2 at physiological pH. In other aspects, the peptide has a charge greater than 3.5 at physiological pH. In still other aspects, the peptide has a charge greater than 4.5 at physiological pH. In some aspects, the peptide has a charge greater than 5.5 at physiological pH. In other aspects, the peptide has a charge greater than 6.5 at physiological pH. In other aspects, the peptide has a charge greater than 7.5 at physiological pH. In still other aspects, the peptide has a charge greater than 8.5 at physiological pH. In other aspects, the peptide has a charge greater than 9.5 at physiological pH.

In some aspects, the peptide is selected from a potassium channel agonist, a potassium channel antagonist, a portion of a potassium channel, a sodium channel agonist, a sodium channel antagonist, a calcium channel agonist, a calcium channel antagonist, a hadrucalcin, a theraphotoxin, a huwentoxin, a kaliotoxin, a cobatoxin, or a lectin.

In further aspects, the lectin is SHL-Ib2. In some aspects, the peptide is arranged in a multimeric structure with at least one other peptide.

In further aspects, the multimeric structure comprises a dimer, trimer, tetramer, pentamer, hexamer, or heptamer. In some aspects, at least one residue of the peptide comprises a chemical modification. In further aspects, the chemical modification is blocking the N-terminus of the peptide. In still further aspects, the chemical modification is methylation, acetylation, or acylation. In other aspects, the chemical modification is: methylation of one or more lysine residues or analogue thereof; methylation of the N-terminus; or methylation of one or more lysine residue or analogue thereof and methylation of the N-terminus. In some aspects, the peptide is linked to an acyl adduct.

In some aspects, the peptide is linked to an active agent. In further aspects, the active agent is fused with the peptide at an N-terminus or a C-terminus of the peptide. In some aspects, the active agent is another peptide. In some aspects, the active agent is an antibody. In other aspects, the active agent is an Fc domain, Fab domain, scFv, or Fv fragment. In still other aspects, the peptide fused with an Fc domain comprises a contiguous sequence.

In further aspects, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 active agents are linked to the peptide. In still further aspects, the peptide is linked to the active agent via a cleavable linker. In some aspects, the peptide is linked to the active agent at an N-terminus, at the epsilon amine of an internal lysine residue, at the carboxylic acid of an aspartic acid or glutamic acid residue, or a C-terminus of the peptide by a linker. In some aspects, the peptide further comprises a non-natural amino acid, wherein the non-natural amino acid is an insertion, appendage, or substitution for another amino acid.

In some aspects, the peptide is linked to the active agent at the non-natural amino acid by a linker. In some aspects, the linker comprises an amide bond, an ester bond, a carbamate bond, a carbonate bond, a hydrazone bond, an oxime bond, a disulfide bond, a thioester bond, a thioether bond, a triazole, a carbon-carbon bond, or a carbon-nitrogen bond. In further aspects, the cleavable linker comprises a cleavage site for matrix metalloproteinases, thrombin, cathepsins, or beta-glucuronidase. In other aspects, the linker is a hydrolytically labile linker. In other aspects, the linker is pH sensitive, reducible, glutathione-sensitive, or protease cleavable. In still other aspects, the peptide is linked to the active agent via a stable linker.

In some aspects, the peptide is linked to a detectable agent. In further aspects, the detectable agent is fused with the peptide at an N-terminus or a C-terminus of the peptide. In still further aspects, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 detectable agents are linked to the peptide. In some aspects, the peptide is linked to the detectable agent via a cleavable linker.

In some aspects, the peptide is linked to the detectable agent at an N-terminus, at the epsilon amine of an internal lysine residue, or a C-terminus of the peptide by a linker. In further aspects, the peptide further comprises a non-natural amino acid, wherein the non-natural amino acid is an insertion, appendage, or substitution for another amino acid. In still further aspects, the peptide is linked to the active agent at the non-natural amino acid by a linker.

In still further aspects, the linker comprises an amide bond, an ester bond, a carbamate bond, a hydrazone bond, an oxime bond, or a carbon-nitrogen bond. In some aspects, the cleavable linker comprises a cleavage site for matrix metalloproteinases, thrombin, cathepsins, or beta-glucuronidase. In other aspects, the peptide is linked to the detectable agent via a stable linker.

In some aspects, the detectable agent is a fluorophore, a near-infrared dye, a contrast agent, a nanoparticle, a metal-containing nanoparticle, a metal chelate, an X-ray contrast agent, a PET agent, a radioisotope, or a radionuclide chelator. In further aspects, the detectable agent is a fluorescent dye. In some aspects, the peptide has an isoelectric point of about 9.

In some aspects, the peptide is SEQ ID NO: 45. In other aspects, the peptide is SEQ ID NO: 132. In still other aspects, the peptide is SEQ ID NO: 33. In some aspects, the peptide is SEQ ID NO: 4. In some aspects, the peptide is SEQ ID NO: 41. In other aspects, the peptide is SEQ ID NO: 5. In still other aspects, the peptide is SEQ ID NO: 6. In some aspects, the peptide is SEQ ID NO: 570. In some aspects, the peptide comprises at least 4, at least 5, at least 6, at least 7, at least 8, at least 9, at least 10, at least 11, at least 12, at least 13, at least 14, at least 15, or at least 16 cysteine residues.

In some aspects, at least one amino acid residue of the peptide is in an L configuration or, wherein at least one amino acid residue is in a D configuration. In some aspects, the peptide comprises or is derived from the group consisting of: chlorotoxins, brazzeins, circulins, stecrisps, hanatoxins, midkines, hefutoxins, potato carboxypeptidase inhibitors, bubble proteins, attractins, αGI, α-GID, μpIIIA, ω-MVIIA, ω-CVID, χ-MrIA, ρ-TIA, conantokin G, contulakin G, GsMTx4, margatoxins, shK, toxin K, chymotrypsin inhibitors (CTI), EGF epiregulin core, hainantoxins, theraphotoxins, hexatoxins, opicalcins, imperatoxins, defensins, and insectotoxins. In some aspects, the peptide comprises or is derived from a human protein or peptide.

In some aspects, the peptide comprises an isoelectric point less than or equal to about 7.5. In some aspects, the peptide comprises an isoelectric point greater than or equal to about 7.5. In other aspects, the peptide comprises an isoelectric point within a range from about 3.0 to about 10.0. In some aspects, the peptide comprises a non-uniform charge distribution. In some aspects, the peptide comprises one or more regions of concentrated positive charge. In some aspects, the peptide comprises one or more regions of concentrated negative charge.

In some aspects, the composition comprises a mass-average molecular weight (Mw) less than or equal to 6 kDa, less than or equal to about 50 kDa, or less than or equal to about 60 kDa. In some aspects, the composition comprises a mass-average molecular weight (Mw) within a range from about 0.5 kDa to about 50 kDa, or within a range from about 0.5 kDa to about 60 kDa. In some aspects, the peptide is stable at pH values greater than or equal to about 7.0. In some aspects, the peptide is stable at pH values less than or equal to about 5.0, less than or equal to about 3.0, or within a range from about 3.0 to about 5.0. In some aspects, the peptide is stable at pH values within a range from about 5.0 to about 7.0. In some aspects, the peptide being stable comprises one or more of: the peptide being capable of performing its therapeutic effect, the peptide being soluble, the peptide being resistant to protease degradation, the peptide being resistant to reduction, the peptide being resistant to pepsin degradation, the peptide being resistant to trypsin degradation, the peptide being reduction resistant, or the peptide being resistant to an elevated temperature.

In some aspects, upon administration to a subject, the peptide homes, targets, is directed to, accumulates in, migrates to, is retained by, or binds to renal tissue of the subject. In further aspects, the peptide homes, targets, is directed to, accumulates in, migrates to, is retained by, or binds to one or more of: a cortex region, a glomerulus, a proximal tubule, a medulla region, a descending tubule, an ascending tubule, a loop of Henle, or a Bowman's capsule of the subject. In still further aspects, the peptide homes, targets, is directed to, accumulates in, migrates to, is retained by, or binds to a proximal tubule of the subject.

In further aspects, the peptide homes, targets, is directed to, accumulates in, migrates to, is retained by, or binds to a cell of the proximal tubule. In some aspects, the peptide homes, targets, is directed to, accumulates in, migrates to, is retained by, or binds to a cell surface receptor expressed by the cell of the proximal tubule. In some aspects, the peptide homes, targets, is directed to, accumulates in, migrates to, is retained by, or binds to a glomerulus of the subject. In other aspects, the peptide homes, targets, is directed to, accumulates in, migrates to, is retained by, or binds to a megalin receptor, a cubulin receptor, or a combination thereof.

In some aspects, the peptide is internalized by a cell. In further aspects, the peptide is internalized by the cell via a scavenging mechanism. In some aspects, the peptide exhibits a renal therapeutic effect. In further aspects, the renal therapeutic effect comprises a renal protective effect or renal prophylactic effect. In some aspects, the peptide interacts with a renal ion channel, inhibits a protease, has antimicrobial activity, has anticancer activity, has anti-inflammatory activity, induces ischemic preconditioning or acquired cytoresistance, or produces a protective or therapeutic effect on a kidney of the subject, or a combination thereof.

In some aspects, the active agent comprises a renal therapeutic agent. In further aspects, the renal therapeutic agent accumulates in the kidney at a higher level when linked to the peptide than when not linked to the peptide. In some aspects, the renal therapeutic agent comprises a renal protective agent or a renal prophylactic agent. In some aspects, the renal therapeutic agent, renal protective agent, or renal prophylactic agent induces ischemic preconditioning or acquired cytoresistance in a kidney of the subject. In some aspects, the active agent interacts with a renal ion channel, inhibits a protease, has antimicrobial activity, has anticancer activity, has anti-inflammatory activity, has a diuretic effect, increases glucose excretion, modulates the immune system, induces ischemic preconditioning or acquired cytoresistance, produces a protective or therapeutic effect on a kidney of the subject, reduces a clearance rate of the composition, or a combination thereof.

In some aspects, the composition further comprises a half-life modifying agent coupled to the peptide. In further aspects, the half-life modifying agent comprises a polymer, a polyethylene glycol (PEG), a hydroxyethyl starch, polyvinyl alcohol, a water soluble polymer, a zwitterionic water soluble polymer, a water soluble poly(amino acid), a water soluble polymer of proline, alanine and serine, a water soluble polymer containing glycine, glutamic acid, and serine, an Fc region, a fatty acid, palmitic acid, or a molecule that binds to albumin.

In some aspects, administration of the composition to a patient mediates inflammation, cell death, fibrosis, or any combination thereof in the kidney. In some aspects, the peptide active agent complex is expressed as a fusion protein. In some aspects, the renal ion channel is a calcium channel, a magnesium channel, a chlorine channel, a hydrogen channel, a potassium channel, a sodium channel, or any combination thereof.

In various aspects, the present disclosure provides a pharmaceutical composition comprising any composition described above or a salt thereof, and a pharmaceutically acceptable carrier. In some aspects, the pharmaceutical composition is formulated for administration to a subject. In further aspects, the pharmaceutical composition is formulated for inhalation, intranasal administration, oral administration, topical administration, parenteral administration, intravenous administration, subcutaneous administration, intramuscular administration, intraperitoneal administration, dermal administration, transdermal administration, or a combination thereof.

In various aspects, the present disclosure provides a method of treating a condition in a subject in need thereof, the method comprising: administering to the subject a peptide comprising any composition described above or any pharmaceutical composition described above. In some aspects, the composition is administered by inhalation, intranasally, orally, topically, parenterally, intravenously, subcutaneously, intramuscularly administration, intraperitoneally, dermally, transdermally, or a combination thereof. In some aspects, the composition homes, targets, or migrates to a kidney of the subject following administration.

In some aspects, the condition is associated with a function of a kidney of the subject. In some aspects, the composition or pharmaceutical composition homes, targets, or migrates to renal tissue of the subject following administration. In some aspects, the condition is associated with a function of a kidney of the subject.

In further aspects, the condition is selected from the group consisting of: acute kidney diseases and disorders (AKD), acute kidney injury, acute and rapidly progressive glomerulonephritis, acute presentations of nephrotic syndrome, acute pyelonephritis, acute renal failure, idiopathic chronic glomerulonephritis, secondary chronic glomerulonephritis, chronic heart failure, chronic interstitial nephritis, chronic kidney disease (CKD), chronic liver disease, chronic pyelonephritis, diabetes, diabetic kidney disease, fibrosis, focal sclerosis, focal segmental glomerulosclerosis, Goodpasture's disease, diabetic nephropathy, hereditary nephropathy, interstitial nephropathy, hypertensive nephrosclerosis, IgG4-related renal disease, interstitial inflammation, lupus nephritis, nephritic syndrome, partial obstruction of the urinary tract, polycystic kidney disease, progressive renal disease, renal cell carcinoma, clear cell renal cell carcinoma, papillary renal cell carincoma, chromophobe renal cell carinoma, kidney cancer, transitional cell carcinoma, nephroblastoma, renal sarcoma, renal adenoma, oncocytoma, angiomyolipoma, renal fibrosis, kidney stones, hypertension, hypotension, disorders of sodium, water, acid-base, potassium, calcium, magnesium, or phosphate balance, infections, urinary tract infections, kidney failure, hematuria, renal cysts, uremia, shock, uretal obstruction, proteinuria, Fanconi's syndrome, Bartter's syndrome, chronic renal insufficiency, renal fibrosis, graft versus host disease after renal tranplant, organ transplant rejection, and vasculitis.

In still further aspects aspects, the condition is lupus nephritis, acute kidney injury (AKI), chronic kidney disease (CKD), hypertensive kidney damage, diabetic nephropathy, or renal fibrosis.

In various aspects, the present disclosure provides a method of imaging an organ or body region of a subject, the method comprising: administering to the subject any composition described above or any pharmaceutical composition described above; and imaging the subject.

In some aspects, the method further comprises detecting a cancer or diseased region, tissue, structure, or cell. In some aspects, the method further comprises performing surgery on the subject. In further aspects, the method further comprises treating the cancer. In some aspects, the surgery comprises removing the cancer or the diseased region, tissue, structure, or cell of the subject. In some aspects, the method further comprises imaging the cancer or diseased region, tissue, structure, or cell of the subject after surgical removal.

In various aspects, the present disclosure provides a method of protecting a kidney of a subject from injury, the method comprising: administering to the subject any composition described above or any pharmaceutical composition described above. In some aspects, the composition is administered by inhalation, intranasally, orally, topically, intravenously, subcutaneously, intramuscularly administration, intraperitoneally, or a combination thereof. In some aspects, the method further comprises inducing ischemic preconditioning or acquired cytoresistance in the kidney of the subject.

In some aspects, the injury is associated with one or more of: surgery, radiocontrast imaging, radiocontrast nephropathy, cardiovascular surgery, cardiopulmonary bypass, extracorporeal membrane oxygenation (ECMO), balloon angioplasty, induced cardiac or cerebral ischemic-reperfusion injury, organ transplantation, kidney transplantation, sepsis, shock, low blood pressure, high blood pressure, kidney hypoperfusion, chemotherapy, drug administration, nephrotoxic drug administration, blunt force trauma, puncture, poison, or smoking.

In some aspects, the composition or pharmaceutical composition is administered at least 1 hour, at least 2 hours, at least 3 hours, at least 4 hours, at least 5 hours, at least 6 hours, at least 7 hours, at least 8 hours, at least 9 hours, at least 10 hours, at least 11 hours, at least 12 hours, at least 13 hours, at least 14 hours, at least 15 hours, at least 16 hours, at least 17 hours, at least 18 hours, at least 19 hours, at least 20 hours, at least 21 hours, at least 22 hours, at least 23 hours, at least 24 hours, at least 36 hours, at least 48 hours, at least 60 hours, at least 72 hours, or at least 96 hours prior to a predicted occurrence of the injury. In some aspects, the composition or pharmaceutical composition is administered once per day, week, or month, or once per two weeks, two months, or three months.

In some aspects, the composition or pharmaceutical composition is administered at least 1 hour, at least 2 hours, at least 3 hours, at least 4 hours, at least 5 hours, at least 6 hours, at least 7 hours, at least 8 hours, at least 9 hours, at least 10 hours, at least 11 hours, at least 12 hours, at least 13 hours, at least 14 hours, at least 15 hours, at least 16 hours, at least 17 hours, at least 18 hours, at least 19 hours, at least 20 hours, at least 21 hours, at least 22 hours, at least 23 hours, at least 24 hours, at least 36 hours, at least 48 hours, at least 60 hours, at least 72 hours, or at least 96 hours after an occurrence of the injury. In some aspects, the method further comprises performing a medical procedure on the subject.

In further aspects, the medical procedure comprises one or more of: surgery, radiocontrast imaging, cardiopulmonary bypass, balloon angioplasty, induced cardiac or cerebral ischemic-reperfusion injury, organ transplantation, chemotherapy, drug administration, or nephrotoxic drug administration. In some aspects, the composition or the pharmaceutical composition is administered at least 1 hour, at least 2 hours, at least 3 hours, at least 4 hours, at least 5 hours, at least 6 hours, at least 7 hours, at least 8 hours, at least 9 hours, at least 10 hours, at least 11 hours, at least 12 hours, at least 13 hours, at least 14 hours, at least 15 hours, at least 16 hours, at least 17 hours, at least 18 hours, at least 19 hours, at least 20 hours, at least 21 hours, at least 22 hours, at least 23 hours, at least 24 hours, at least 36 hours, at least 48 hours, at least 60 hours, at least 72 hours, or at least 96 hours prior to performing the medical procedure.

In some aspects, the composition or the pharmaceutical composition is administered at least 1 hour, at least 2 hours, at least 3 hours, at least 4 hours, at least 5 hours, at least 6 hours, at least 7 hours, at least 8 hours, at least 9 hours, at least 10 hours, at least 11 hours, at least 12 hours, at least 13 hours, at least 14 hours, at least 15 hours, at least 16 hours, at least 17 hours, at least 18 hours, at least 19 hours, at least 20 hours, at least 21 hours, at least 22 hours, at least 23 hours, at least 24 hours, at least 36 hours, at least 48 hours, at least 60 hours, at least 72 hours, or at least 96 hours after performing the medical procedure.

INCORPORATION BY REFERENCE

All publications, patents, and patent applications mentioned, disclosed or referenced in this specification are herein incorporated by reference in their entirety and to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference.

BRIEF DESCRIPTION OF THE FIGURES

The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present disclosure will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the disclosure are utilized, and the accompanying drawings of which:

FIG. 1 illustrates an exemplary architecture of constructs expressing sequences of SEQ ID NO: X, where X can be any one of peptides of SEQ ID NO: 21-SEQ ID NO: 33.

FIG. 2 illustrates a schematic of a method of manufacturing of a peptide of the disclosure.

FIG. 3 shows renal signal patterns for a peptide of SEQ ID NO: 4. FIG. 3A shows accumulation of ¹⁴C signal for radiolabeled SEQ ID NO: 4 three hours after peptide administration. FIG. 3B shows accumulation of ¹⁴C signal for a peptide of SEQ ID NO: 4 twenty-four hours after peptide administration.

FIG. 4 shows whole body fluorescence images of mice after administration of SEQ ID NO: 132 conjugated to Cy5.5 (SEQ ID NO: 132-Cy5.5) (left) versus after administration of free Cy5.5-COOH alone (right). FIG. 4A shows a whole body fluorescence image of a mouse 3 hours after administration of 10 nmol SEQ ID NO: 132-Cy5.5. The arrow indicates the position and fluorescence signal in the kidney. FIG. 4B shows a whole body fluorescence image of a mouse 3 hours after administration of 10 nmol Cy5.5-COOH. The arrow indicates the position and fluorescence signal in the kidney. FIG. 4C shows a whole body fluorescence image of a mouse after 24 hours after administration of 10 nmol SEQ ID NO: 132-Cy5.5. The arrow indicates the position and fluorescence signal in the kidney. FIG. 4D shows a whole body fluorescence image of a mouse 24 hours after administration of 10 nmol Cy5.5-COOH. The arrow indicates the position and fluorescence signal in the kidney. FIG. 4E shows a whole body fluorescence image of a mouse 48 hours after administration of 10 nmol SEQ ID NO: 132-Cy5.5. The arrow indicates the position and fluorescence signal in the kidney. FIG. 4F shows a whole body fluorescence image of a mouse 48 hours after administration of 10 nmol Cy5.5-COOH. The arrow indicates the position and fluorescence signal in the kidney. FIG. 4G shows a whole body fluorescence image of a mouse 72 hours after administration of 10 nmol SEQ ID NO: 132-Cy5.5. The arrow indicates the position and fluorescence signal in the kidney. FIG. 411 shows a whole body fluorescence image of a mouse 72 hours after administration of 10 nmol Cy5.5-COOH. The arrow indicates the position and fluorescence signal in the kidney.

FIG. 5 shows fluorescence of kidney sections from mice, in which each mouse received 10 nmol free AlexFluor 647 fluorophore (AF647), 10 nmol SEQ ID NO: 41 conjugated to AF647, 10 nmol SEQ ID NO: 5 conjugated to AF647, or 10 nmol SEQ ID NO: 33 conjugated to AF647. Each kidney was from an independent mouse.

FIG. 6 shows SEQ ID NO: 5 conjugated to AF647 and SEQ ID NO: 41 conjugated to AF647 fluorescence signal in confocal images of the kidney cortex. FIG. 6A shows fluorescence signal of SEQ ID NO: 5 conjugated to AF647 in the kidney cortex 20 hours after of administration of 10 nmol of the peptide-dye conjugate at 6× magnification. FIG. 6B shows fluorescence signal of SEQ ID NO: 5 conjugated to AF647 in the kidney cortex 20 hours after administration of 10 nmol of the peptide-dye conjugate at 20× magnification. FIG. 6C shows fluorescence signal of SEQ ID NO: 5 conjugated to AF647 in the kidney cortex 20 hours after administration of 10 nmol of the peptide-dye conjugate at 6× magnification. FIG. 6D shows fluorescence signal of SEQ ID NO: 5 conjugated to AF647in the kidney cortex 20 hours after of administration of 10 nmol of the peptide-dye conjugate at 20× magnification.

FIG. 7 shows SEQ ID NO: 33 conjugated to AF647 fluorescence signal in confocal images of the kidney cortex. FIG. 7A shows fluorescence signal of SEQ ID NO: 33 conjugated to AF647 in the kidney cortex 20 hours after administration of 10 nmol of the peptide-dye conjugate at 6× magnification. FIG. 7B shows fluorescence signal of SEQ ID NO: 33 conjugated to AF647 in the kidney cortex 20 hours after administration of 10 nmol of the peptide-dye conjugate at 20× magnification. FIG. 7C shows fluorescence signal in the kidney cortex 20 hours after administration of 10 nmol of a lysozyme-dye conjugate at 6× magnification. FIG. 7D shows fluorescence signal in the kidney cortex 20 hours after of administration of 10 nmol of a lysozyme-dye conjugate at 20× magnification.

FIG. 8 shows quantified fluorescence signal, indicating renal uptake, of a peptide of SEQ ID NO: 4 conjugated to AlexaFluor647 (AF647) and an unlabeled SEQ ID NO: 4 peptide 4 hours after intravenous administration of 2 nmol of SEQ ID NO: 4-AF647, 10 nmol of SEQ ID NO: 4 (1:5) co-injected with 2 nmol of SEQ ID NO: 4-AF647 (5:1), or 50 nmol of SEQ ID NO: 4 co-injected with 2 nmol of SEQ ID NO: 4-AF647 (25:1). Kidneys from uninjected mice were used as a negative control.

FIG. 9 shows quantified fluorescence signal, indicating renal uptake, between a peptide of SEQ ID NO: 4 conjugated to AlexaFluor647 (AF647) and unlabeled KKEEEKKEEEKKEEEKK competitor peptide (SEQ ID NO: 571, a known renal targeting peptide) 1 hour after intravenous administration of 2 nmol of a peptide of SEQ ID NO: 4-AF647, 2 nmol of a peptide of SEQ ID NO: 4-AF647 co-injected with 100 nmol of an unlabeled peptide of SEQ ID NO: 571 (1:50), or 2 nmol of peptide of SEQ ID NO: 4-AF647 co-injected with 2000 nmol of an unlabeled peptide of SEQ ID NO: 571 (1:1000).

FIG. 10 shows quantified fluorescence signal, indicating renal uptake, between a peptide of SEQ ID NO: 4 conjugated to AlexaFluor647 (AF647) and a control peptide conjugated to AF647 (control peptide-AF647), 4 hours after intravenous administration of 10 nmol of a peptide of SEQ ID NO: 4-AF647 or 10 nmol of a peptide of control peptide-AF647.1

DETAILED DESCRIPTION

The present disclosure relates generally to compositions and methods for renal therapy. In some embodiments, the compositions and methods herein utilize peptides that home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to a kidney following administration to a subject. In some embodiments, the kidney homing peptides of the present disclosure exert a therapeutic effect in a kidney, or a tissue or a cell thereof. In some embodiments, the kidney homing peptides of the present disclosure are used to deliver an active agent to a kidney, or a tissue or a cell thereof. The active agent can exert a therapeutic effect on a kidney, or a tissue or a cell thereof. For example, in certain embodiments, the peptide itself or the active agent allows for localized delivery of an anti-inflammatory or other agent to a kidney, or a tissue or a cell thereof. As another example, the active agent is a fluorophore that can be used for imaging of a kidney. In certain embodiments, the peptide itself induces therapeutic responses.

Kidney disorders can be particularly difficult to treat. A direct route for active agent administration to the kidney can be parenterally (e.g., intravenously, subcutaneously, intramuscularly), directly into the kidney, intra-articularly, by inhalation, dermally, topically, or orally. Drugs for kidney diseases can be injected directly locally into the affected area, for example, directly injected into the kidney or specific structures within the kidney. Few drugs aimed at treating kidney disorders have proved therapeutically viable due primarily to rapid clearance in a kidney as well as a lack of access to the target kidney tissue. The lack of access to the target tissue and rapid clearance can also lead to administration of doses that are higher than would be necessary if a drug could home, target, or be directed to, is retained by, and/or binds to a target region, tissue, structure, or cell. Thus, treatment of kidney conditions often requires the use of high concentrations of non-specific drugs. In addition, a number of therapeutics are of interest in treating kidney disorders, but are problematic because of the level of side effects caused by systemic administration of the drug (Brenner and Rector's The Kidney, Skorecki et al, Elsevier, 10^(th) Edition, 2016).

Specific and potent drugs that are capable of contacting the kidney can counteract the non-specificity of many treatments by selectively targeting and delivering compounds to specific regions, tissues, cells and structures. Such drugs can also be useful to modulate ion channels, protein-protein interactions, extracellular matrix remodeling (e.g., protease inhibition), and the like. Such targeted therapy can allow for lower dosing, reduced side effects, improved patient compliance, and improvement in therapeutic outcomes, which would be advantageous not only in acute disease of the kidney, but in chronic conditions as well.

The present disclosure provides peptides that can comprise or can be derived from cystine-dense peptides. As used herein, the term “cystine-dense peptide” can be interchangeable with the terms “knotted peptide,” “knottin,” and “optide,” and cystine-dense peptides can also be abbreviated as “CDPs.” Hitchins, amongst other disulfide-containing peptides, can also be considered “knotted peptides” or “cystine-dense peptides” for the purposes of this disclosure. Knottins, for example, are a class of cystine-dense peptides comprising from about 11 to about 80 amino acids in length that are often folded into a compact structure. Knottins and other cystine-dense peptides are typically assembled into a complex tertiary structure that is characterized by a number of intramolecular disulfide crosslinks and can contain beta strands, an alpha helix, and other secondary structures. The presence of the disulfide bonds can give cystine-dense peptides remarkable environmental stability, allowing them to withstand extremes of temperature and pH, to resist proteolytic enzymes in the blood stream or digestive tract, and can provide specific biodistribution, pharmacokinetic, binding interactions, cellular processing, or other properties of physiologic and therapeutic value. The peptides disclosed herein can be derived from certain cystine-dense peptides. The present disclosure describes a class of cystine-dense peptides that can effectively contact kidney and be used either directly or as carriers of active drugs, peptides, or molecules to treat a kidney condition.

Also described herein are peptides that can selectively home, target, are directed to, migrate to, are retained by, or accumulate in and/or bind to specific regions, tissues, structures, or cells of the kidney that aid in managing, decreasing, ablating or reducing pain due to chronic disease or kidney injury or other therapeutic indications as described herein. A peptide that homes, targets, migrates to, is directed to, is retained by, or accumulates in and/or binds to one or more specific regions, tissues, structures, or cells of the kidney can have fewer off-target and potentially negative effects, for example, side effects that often limit use and efficacy of pain drugs. In addition, such peptides can reduce dosage and increase the efficacy of existing drugs by directly targeting them to a specific region, tissue, structure or cell of the kidney and helping the contact the kidney or increasing the local concentration of agent. The peptide itself can modulate pain or it can be conjugated to an agent that modulates pain. Such pain modulation may operate by various mechanisms such as modulating inflammation, autoimmune responses, direct or indirect action on pain receptors, cell killing, or programmed cell death (whether via an apoptotic and/or non-apoptotic pathway of diseased cells or tissues, and the like (Tait et al., J Cell Sci 127(Pt 10):2135-44 (2014)).

Peptides of this disclosure that home, target, are directed to, migrate to, are retained by, accumulate in, or bind to specificregions, tissues, structures, or cells of the kidney can do so with different degrees of efficiency. Peptides can have a higher concentration in kidney than in other locations, such as blood or muscle. Peptides can be recorded as having a signal in kidney as a percentage of signal in blood. For example, a kidney signal of 200% indicates that the signal in kidney is twice as high as the signal in blood. In some embodiments, peptides that have kidney homing properties can have a kidney signal of from >200% to >4000% by radiographic densitometry measurements. In other embodiments, peptides that are kidney homers can have a kidney signal of >200% by radiographic densitometry measurements. In other embodiments, peptides that are more efficient kidney homers can have a kidney signal of >300% by radiographic densitometry measurements. In other embodiments, peptides that are more efficient kidney homers can have a kidney signal of >400% by radiographic densitometry measurements. In other embodiments, peptides that are strongest kidney homers of highest interest can have a kidney signal of >500% by radiographic densitometry measurements, a kidney signal of >600% by radiographic densitometry measurements, or a kidney signal of >4000% by radiographic densitometry measurements. In some embodiments, peptides that are the strongest kidney homers can have a kidney signal of from >600% to >4000%, from >600% to >700%, from >700% to >800%, from >800% to >900%, from >900% to >1000%, from >1000% to >2000%, from >2000% to >3000%, from >3000% to >4000%, or greater than 4000%. In some embodiments, measurement of the ratio of peptide concentration in blood, muscle, or other tissues relative to the peptide concentration in kidney can be performed using various methods including measuring the densitometry signal of peptides labeled with radioisotopes (as described above), or by using other assays.

Peptides that selectively home, target, are directed to, migrate to, are retained by, or accumulate in and/or bind to specificregions, tissues, structures, or cells of the kidney can occur after administration of the peptide to a subject. A subject can be a human or a non-human animal.

The present disclosure relates generally to compositions and methods for renal therapy. In some embodiments, the compositions and methods herein utilize peptides that can home, target, are directed to, accumulate in, migrate to, are retained by and/or bind to the kidneys following administration to a subject. In certain embodiments, the peptides described herein can bind to or accumulate in a specific region, tissue, structure, or cell of a kidney, e.g., the proximal tubule, the glomerulus, or the glomerular filtrate (Bowman's space) tubular lumina. The properties of the peptide (e.g., isoelectric point (pI), molecular weight, pH stability, reduction resistance, protease resistance, hydrophobicity/hydrophilicity, charge, etc.) can be selected to provide improved renal localization and binding. In some embodiments, the renal homing peptides of the present disclosure are used to deliver an active agent to the kidney or a tissue, region, compartment or cell thereof. The active agent can exert a therapeutic effect on the kidney or a tissue or cell thereof. For example, in certain embodiments, the active agent induces a protective response such as ischemic preconditioning or acquired cytoresistance in the kidney or tissue or cell thereof. As another example, in certain embodiments, the active agent induces a therapeutic response in a diseased kidney or tissue, region, compartment or cell thereof. In certain embodiments, the peptide itself induces such protective and therapeutic responses, such as by binding to ion channels, exerting an antimicrobial effect, or inhibiting protease(s).

Iron (Fe) mediated oxidative stress and renal interstitial inflammation can lead to progressive nephron loss and renal interstitial fibrosis. The severity of the latter, as assessed on kidney biopsy, can be a predictor of subsequent loss of renal function. Despite recognition of their pathogenic roles, therapies targeted at Fe-mediated oxidative stress and renal inflammation have been hampered by two dominant factors: 1) an inability to achieve sufficient intrarenal concentrations of potent antioxidant/Fe binding agents (e.g., deferoxamine); and 2) associated systemic toxicities (e.g., with glucocorticoids, cyclophosphamide therapies). A molecule that can distribute sufficient levels of a therapeutic agent to the kidney while reducing the levels of the agent delivered to other areas of the body such as to reduce off-target toxicities may be able to achieve a therapeutic window that allows treatment of the kidney with the agent with a sufficient safety profile. Likewise, an active molecule that can accumulate in the kidney with reduced distribution to other tissues may be able to achieve a therapeutic effect in the kidney while sufficiently sparing other tissues from side effects. For example, steroid treatment of the kidney can be limited by toxicity side effects in other parts of the body and in particular, can be contraindicated in diabetic patients due to off-target toxicities.

In some embodiments, the present disclosure sets forth pro-drugs that specifically target the kidney. In some cases, low molecular weight proteins in plasma (LMWPs; <35 kDa) can be freely filtered by the glomerulus, and can be almost fully reabsorbed by proximal tubules (which represent ˜70% of total renal cortical mass). The reabsorbed protein can be degraded within the proximal tubular lysosomal system. Thus, by binding small therapeutic molecules to a specific LMWP, the bound agent(s) can be tunably released from its carrier protein within tubular cells, gaining access to the tubular cytosol, and subsequently, the renal interstitial compartment (the dominant site of the renal inflammatory response).

The present disclosure provides a number of peptides that can be rapidly, highly, and persistently taken up by or can accumulate in proximal tubule cells or in the glomerular filtrate (Bowman's space) tubular lumina. These peptides can prevent and treat a host of acute and progressive renal diseases or can be linked to a therapeutic molecule that can prevent and treat a host of acute and progressive renal diseases. Given that many renal diseases, both acute and chronic, can be mediated in large part by both inflammation and iron mediated oxidative stress, the peptide-drug conjugates of the present disclosure can be applicable in a wide range of clinical settings.

The peptides disclosed herein also can provide several advantages over other known approaches for treatment of acute or progressive renal disease. For example, a peptide of this disclosure can deliver molecules intracellularly, and thus act on intracellular targets as compared to other approaches. Additionally, as compared to treatment using lysozyme or myoglobin, a peptide of the disclosure can have reduced immunogenicity, be soluble in kidney compartments, have a lack of toxicity or reduced toxicity to kidney, and can be resistant to reduction and/or to proteases (Zhou et al. Acta Pharm Sin B. 2014 Feb.; 4(1):37-42). A peptide as disclosed herein can also have a controlled and/or single site for drug conjugation as compared to other known treatments. For example, both a lysozyme (Haas 1997) and another previously known kidney targeting peptide, KKEEEKKEEEKKEEEKK (SEQ ID NO: 571), can comprise multiple lysine residues as compared with a peptide of the disclosure, such as SEQ ID NO: 41, SEQ ID NO: 132, SEQ ID NO: 130, SEQ ID NO: 131, SEQ ID NO: 135, SEQ ID NO: 219, SEQ ID NO: 4, SEQ ID NO: 5, and SEQ ID NO: 33, which have been or can be engineered to have no lysine residue. The absence of a lysine residue on a peptide of the disclosure can allow for site specific amine conjugation at the N-terminus of the peptide or can allow for a single lysine residue to be a site specific conjugation. Lysine residues in some peptides can be essential for accumulation in the kidney, such that multiple conjugations on the lysine residues can reduce kidney accumulation and substitutions of lysine residues with arginine residues, to maintain positive charge, can, with some peptides, result in reduced accumulation in kidney (Wischnjow et al. Bioconjug Chem. 2016 Apr. 20; 27(4):1050-7, Janzer et al. Bioconjug Chem. 2016 Oct. 4), whereas peptides of this disclosure can contain no lysine residues and still accumulate in the kidney.

The presence of multiple lysines on a peptide can result in multiple sites of conjugation, and can thereby result in heterogeneous conjugates. Similarly, therapeutic molecules like chitosan or polyvinylpyrrolidone can also have multiple conjugation sites that can confound preparation of a desired homogenous peptide drug conjugate (He 2012, Wischnjow et al. Bioconjug Chem. 2016 Apr. 20; 27(4):1050-7). Furthermore, lysozyme can have cardiovascular side effects in comparison with a peptide of this disclosure, While small molecule drugs can readily perfuse the kidney, a method for renal targeting can provide drug uptake into cells, accumulation of drug in the proximal tubules, retention of drug in the kidney, and can reduce systemic exposure to the drug (Janzer et al. Bioconjug Chem. 2016 Oct. 4).

In some embodiments, any peptide of this disclosure can be grafted to another moiety to enhance binding and/or accumulation in the kidney. For example, other targeting peptides can be grafted to any of the peptides of this disclosure in order to enhance, change, or modify the properties of the peptides of the present disclosure. These other targeting peptides can have positively charged residues, which can increase binding of peptides to proximal tubule cells, to megalin (which is negatively charged), or can otherwise increase retention in the kidney (Janzer et al. Bioconjug Chem. 2016 Oct. 4, Geng et al. Bioconjug Chem. 2012 Jun. 20; 23(6):1200-10, Wischnjow et al. Bioconjug Chem. 2016 Apr. 20; 27(4):1050-7). Any of the peptide sequences described in Wischnjow et al. Bioconjug Chem. 2016 Apr. 20; 27(4):1050-7; Janzer et al. Bioconjug Chem. 2016 Oct. 4, Geng et al. Bioconjug Chem. 2012 Jun. 20; 23(6):1200-10 can be grafted to a peptide of the present disclosure, and are incorporated herein by reference. These other peptides can modify the properties of the peptides of the present disclosure by changing charge, changing absorbtion properties into the proximal tubules, or changing targeting of specific structures within the kidney.

For example, other targeting peptides can include Y(KKEEE)₃K (SEQ ID NO: 624), Y(KKEE)₅K (SEQ ID NO: 625), Y(KKQQQ)₃K (SEQ ID NO: 626), Y(MARIA)₃ (SEQ ID NO: 627), (KKEEE)₃K (SEQ ID NO: 628), (KKEE)₅K (SEQ ID NO: 629), (KKQQQ)₃K (SEQ ID NO: 630), (MARIA)₃ (SEQ ID NO: 631), (APASLYN)₂ (SEQ ID NO: 632), and ANTPCGPYTHDCPCKR (SEQ ID NO: 633). Any L-Tyr residue in any of the foregoing can be modified to D-Tyr, for example, for the purposes of radiolabeling.

The peptides disclosed herein can be used as active agents, conjugated to detection agents such a fluorophores, iodide-containing X-ray contrast agents, lanthanide chelates (e.g., gadolinium for MRI imaging), perfluorocarbons (for ultrasound), or PET tracers (e.g., 18F or 11C) for imaging and tracing the peptide, or conjugated to agents such as anti-inflammatory active agents or other active agents to the joint to treat inflammation or other disease.

The peptides disclosed herein can be used to bind kidney explants ex vivo as well as kidney tissues, cells, and cell lines. Kidney explants can be from any subject, such as a human or an animal. Assessment of peptide binding to kidney explants can be used to screen peptides that may efficiently home to kidney in vivo.

In some embodiments, peptides of this disclosure home, target, are directed to, migrate to, are retained by, accumulate in, or bind to specificregions, tissues, structures, or cells of the kidneys. For example, in some embodiments, peptides of this disclosure home, target, are directed to, migrate to, are retained by, accumulate in, or bind to the proximal tubules of the kidneys, kidney nephrons, or podocytes. Peptides that selectively home, target, are directed to, migrate to, are retained by, or accumulate in and/or bind to specificregions, tissues, structures, or cells of the kidney can occur after administration of the peptide to a subject. A subject can be a human or a non-human animal. The peptides disclosed herein can be used as active agents, or conjugated to detection agents such a fluorophores, iodide-containing X-ray contrast agents, lanthanide chelates (e.g., gadolinium for MRI imaging), perfluorocarbons (for ultrasound), or PET tracers (e.g. 18F or 11C) for imaging and tracing the peptide, or conjugated to agents such as anti-inflammatory agents or other agents to the kidney to treat renal cancer, chronic kidney failure or other kidney disease.

One roadblock in the advancement and wide spread use of peptides as a therapeutic is that peptides can be chemically and physically unstable. During the process of manufacturing of therapeutic peptides essential considerations can include storage conditions, sustained biochemical function, and in vivo delivery. Peptide degradation products can result in the formation of species that alter the safety profile, potency, and immunogenicity of the peptide. These peptide degradation products can form during manufacture and storage, as well as in vivo after delivery to a patient. Furthermore, peptide degradation may limit the shelf-life and increase production cost due to unstable peptides requiring refrigeration or shipment on dry ice. The latter can necessitate continual monitoring and validation of peptides as degradation products could have formed during the manufacturing process. Hence, there is an urgent need for the rationale design and production of therapeutic peptides that have enhanced stability, for example, in the ambient environment, during the process of manufacturing, in storage, and that prevent the likelihood of peptide degradation under a variety of conditions.

In some embodiments, the peptides and peptide-drug conjugates of the present disclosure have stability properties that minimize peptide or peptide-drug conjugate degradation to enable adequate storage. Long term, accelerated, and intermediate storage conditions for the peptides and peptide-drug conjugates of the present disclosure can include long term storage conditions of 25° C.±2° C./60% relative humidity (RH)±5% RH, or 30° C.±2° C./65% RH±5% RH for at least 6 months, at least 12 months, and up to 1 year, up to 2 years, up to 3 years, up to 4 years, or longer than 4 years. In addition, intermediate and short term storage conditions (e.g., during transport, distribution, manufacturing, or handling), or long term storage conditions for certain climates and infrastructures, can include storage conditions of 30° C.±2° C./65% RH±5% RH or 40° C.±2° C./75% RH±5% RH for up to 1 hour, for up to 8 hours, for up to 1 day, for up to 3 days, for up to 1 week, for up to 1 month, for up to 3 months, for up to 6 months or at least 6 months, up to 1 year, up to 2 years, up to 3 years, up to 4 years, or longer than 4 years. Moreover, the peptides and peptide-drug conjugates of the present disclosure can be refrigerated, for example between 5° C.±3° C. for at least 6 months, at least 12 months, and up to 1 year, up to 2 years, up to 3 years, up to 4 years, or longer than 4 years. In addition, intermediate and short term refrigeration conditions (e.g., during transport, distribution, manufacturing, or handling) can include 25° C.±2° C./60% RH±5% RH for up to 1 hour, for up to 8 hours, for up to 1 day, for up to 3 days, for up to 1 week, for up to 1 month, for up to 3 months, for up to 6 months or at least 6 months, and potentially longer (at least 12 months and up to 1 year, up to 2 years, up to 3 years, up to 4 years, or longer than 4 years). Such conditions for storage, whether based on ambient or refrigerated conditions can be adjusted based upon the four zones in the world (e.g., the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) stability Zone I, II, III, or IV) that are distinguished by their characteristic prevalent annual climatic conditions. In addition, formulation components can be principally chosen for their ability to preserve the native conformation and chemical structure of the peptides and peptide-drug conjugates of the present disclosure in storage by preventing denaturation due to hydrophobic interactions and aggregation, as well as by preventing chemical degradation, including truncation, oxidation, deamidation, cleavage, hydrolysis, isomerization, disulfide exchange, racemization, and beta elimination (Cleland, et al., Crit Rev Ther Drug Carrier Syst 10(4): 307-377 (1993); Shire et al., J Pharm Sci 93(6): 1390-1402 (2004); Wakankar and Borchardt, J Pharm Sci 95(11): 2321-2336 (2006)).

In some embodiments, the peptides and peptide-drug conjugates of the present disclosure have incorporated properties that minimize immunogenicity of the peptides and peptide-drug conjugates. Immunogenicity can be a major concern with the development of therapeutic peptides and proteins, and there is an urgent need for the rationale design and production of therapeutic peptides that have reduced immunogenicity and that increase their safety and efficacy. Immunogenicity can occur against a desired peptide sequence or a peptide degradation product. Immunogenicity can occur when a patient develops an immune response to the therapeutic peptide, protein, conjugate, or other drug, such as by producing antibodies that bind to and/or neutralize the therapeutic peptide, protein, conjugate, or other drug. The likelihood of immunogenicity can increase when drugs are administered more than once or chronically. Immunogenicity can reduce patient exposure to the drug, can reduce effectiveness of the drug, and can also result in safety risks for the patient, such as generating an immune response to self-proteins or other adverse responses related to increased immunogenicity to the therapeutic peptide, protein, conjugate, or other drug. Immunogenic responses can vary from patient to patient and also amongst different groups of HLA alleles, as well as over time. As such, minimizing risk of immunogenicity with a therapeutic peptide or protein can be important for developing a drug that can be effectively and safely used for treatment. Various methods exist for assessment of immunogenic potential, which can include in silico methods, in vitro testing, preclinical in vivo testing, and assessment during clinical dosing. Evaluation early in product design and development of the therapeutic peptides and peptide-drug conjugates of the present disclosure in the in vivo milieu in which they function (e.g., in inflammatory environments or at physiologic pH) can reveal susceptibilities to modifications (e.g., aggregation and deamidation) that can result in loss of efficacy or induction of immune responses. Such information can be used to facilitate product engineering to enhance the stability of the product under such in vivo conditions or reduce immunogenicity. Moreover, the therapeutic peptides and peptide-drug conjugates of the present disclosure can be designed to minimize protein aggregation. Strategies to minimize aggregate formation can be used early in drug development, for example, by using an appropriate cell substrate, selecting manufacturing conditions that minimize aggregate formation, employing a robust purification scheme that removes aggregates to the greatest extent possible, and choosing a formulation and container closure system that minimize aggregation during storage.

Additional aspects and advantages of the present disclosure will become apparent to those skilled in this art from the following detailed description, wherein illustrative embodiments of the present disclosure are shown and described. As will be realized, the present disclosure is capable of other and different embodiments, and its several details are capable of modifications in various respects, all without departing from the disclosure. Accordingly, the drawings and description are to be regarded as illustrative in nature, and not as restrictive.

As used herein, the abbreviations for the natural L-enantiomeric amino acids are conventional and are as follows: alanine (A, Ala); arginine (R, Arg); asparagine (N, Asn); aspartic acid (D, Asp); cysteine (C, Cys); glutamic acid (E, Glu); glutamine (Q, Gln); glycine (G, Gly); histidine (H, His); isoleucine (I, Ile); leucine (L, Leu); lysine (K, Lys); methionine (M, Met); phenylalanine (F, Phe); proline (P, Pro); serine (S, Ser); threonine (T, Thr); tryptophan (W, Trp); tyrosine (Y, Tyr); valine (V, Val). Typically, Xaa can indicate any amino acid. In some embodiments, X can be asparagine (N), glutamine (Q), histidine (H), lysine (K), or arginine (R). D amino acids are denoted with lower case letters.

Some embodiments of the disclosure contemplate D-amino acid residues of any standard or non-standard amino acid or analogue thereof. When an amino acid sequence is represented as a series of three-letter or one-letter amino acid abbreviations, the left-hand direction is the amino terminal direction and the right-hand direction is the carboxy terminal direction, in accordance with standard usage and convention.

Peptides

The cystine-dense peptides herein can bind targets with antibody-like affinity. The cystine-dense peptides can modulate the activity of a plurality of renal regions, tissues, structures, or cells. For example, in some embodiments, the cystine-dense peptide conjugated to a chemotherapeutic or pain-modifying drug homes to the kidney of a diseased kidney and releases the drug, creating a higher local concentration of drug in an area of diseased or damaged kidney than would be achieved without the kidney targeting function of the peptide. The cystine-dense peptide can be conjugated to a drug that can affect nearby tissues or cells such as podocytes, parietal cells, brush border cells, glomeruli, nephrons, proximal tubules, distal tubules, collecting ducts, interstitial cells, Bowman's capsule, the Loop of Henle, the kidney cortex, the kidney medulla, the calyces, the renal pelvis,kidney connective tissue, blood vessels, peripheral nerves, fibroblasts, monocytes/macrophages, lymphocytes, plasma cells, adipocytes, endothelial cells, neurons, or any combination thereof. The cystine-dense peptide conjugated to a drug can bind to, home to, migrate to, accumulate in, be retained by, or be directed to a kidney and its components. Additionally, in some embodiments, cystine-dense peptides can penetrate into cells. In other embodiments, cystine-dense peptides do not enter cells. In other embodiments, cystine-dense peptides exhibit more rapid clearance and cellular uptake compared to other types of molecules.

The peptides of the present disclosure can comprise cysteine amino acid residues. In some cases, the peptide has at least 4 cysteine amino acid residues. In some cases, the peptide has at least 6 cysteine amino acid residues. In other cases, the peptide has at least 8 cysteine amino acid residues, at least 10 cysteine amino acid residues, at least 12 cysteine amino acid residues, at least 14 cysteine amino acid residues or at least 16 cysteine amino acid residues.

A cystine-dense peptide can comprise disulfide bridges. A cystine-dense peptide can be a peptide wherein 5% or more of the residues are cysteines forming intramolecular disulfide bonds as cystines. A disulfide-linked peptide can be a drug scaffold. In some embodiments, the disulfide bridges form an inhibitor knot. A disulfide bridge can be formed between cysteine residues, for example, between cysteines 1 and 4, 2 and 5, or 3 and 6. In some cases, one disulfide bridge passes through a loop formed by the other two disulfide bridges, for example, to form the inhibitor knot. In other cases, the disulfide bridges can be formed between any two cysteine residues.

The present disclosure further includes peptide scaffolds that, e.g., can be used as a starting point for generating additional peptides that can target and home to a kidney. In some embodiments, these scaffolds can be derived from a variety of cystine-dense peptides. In certain embodiments, cystine-dense peptides are assembled into a complex tertiary structure that is characterized by a number of intramolecular disulfide crosslinks, and optionally contain beta strands and other secondary structures such as an alpha helix. For example, cystine-dense peptides include, in some embodiments, small disulfide-rich proteins characterized by a disulfide through disulfide knot. This knot can be, e.g., obtained when one disulfide bridge crosses the macrocycle formed by two other disulfides and the interconnecting backbone. In some embodiments, the cystine-dense peptides can include growth factor cysteine knots or inhibitor cysteine knots. Other possible peptide structures can include peptide having two parallel helices linked by two disulfide bridges without β-sheets (e.g., hefutoxin).

A cystine-dense peptide can comprise at least one amino acid residue in an L configuration. A cystine-dense peptide can comprise at least one amino acid residue in a D configuration. In some embodiments, a cystine-dense peptide is 22-63 amino acid residues long. In some embodiments, a cystine-dense peptide is 15-40 amino acid residues long. In other embodiments, a cystine-dense peptide is 11-57 amino acid residues long. In further embodiments, a cystine-dense peptide is at least 20 amino acid residues long.

In certain embodiments, the peptides of the present disclosure comprise or are derived from a human protein or peptide that comprises a cystine-dense peptide. Examples of such human proteins or peptides include but are not limited to: bone morphogenic protein 7, gremlin, Cerberus, human chorionic gonadotrophin (hCG), AgRP, siderocalin, receptor-associated protein (RAP), ANKRA2, LRP2BP, DAB2, lactoferrin, and other known megalin/cubulin interactors. Optionally, the human proteins or peptides provided herein are used for motif grafting onto cystine-dense peptide scaffolds.

In alternative embodiments, the peptides of the present disclosure comprise or are derived from a non-human protein or peptide that comprises a cystine-dense peptide, but are modified to include amino acid sequences found in human proteins or peptides. Such modifications can be performed in order to enable binding to human targets (e.g., grafting a known epitope from a human protein that binds to the megalin/cubulin receptor in order to promote proximal tubule binding).

In some embodiments, the peptides of the present disclosure comprise one or more cysteine amino acid residues. In certain embodiments, the peptide comprises at least 4, at least 5, at least 6, at least 7, at least 8, at least 9, at least 10, at least 11, at least 12, at least 13, at least 14, at least 15, or at least 16 cysteine residues.

A cystine-dense peptide can comprise disulfide bridges. A cystine-dense peptide can be a peptide wherein 5% or more of the residues are cysteines forming intramolecular disulfide bonds. A disulfide-linked peptide can be a drug scaffold. In some embodiments, the peptides of the present disclosure comprise a plurality of disulfide bridges forming an inhibitor knot. In certain embodiments, the disulfide bridges are formed between cysteine residues of the peptide.

For example, in various embodiments, the 1^(st) cysteine residue in the sequence is disulfide bonded with the 4^(th) cysteine residue in the sequence, the 2^(nd) cysteine residue in the sequence is disulfide bonded with the 5^(th) cysteine residue in the sequence, and/or the 3^(rd) cysteine residue in the sequence is disulfide bonded with the 6^(th) cysteine residue in the sequence. In alternative embodiments, the disulfide bridges can be formed between any two cysteine residues. In some cases, one disulfide bridge passes through a loop or ring formed by two other disulfide bridges, for example, to form a disulfide through disulfide knot (e.g., an inhibitor knot), also known as a “two-and-through” system.

In some embodiments, the peptide contains one or more disulfide bonds and has a positive net charge at neutral pH, where the net charge of the peptide is greater than or equal to 0 and less than or equal to +30 or where the net charge of the peptide is greater than or equal to −30 and less than or equal to 0. For example, in some embodiments, the peptide has a positive net charge at neutral pH, where the net charge is +0.5 or less than +0.5, +1 or less than +1, +1.5 or less than +1.5, +2 or less than +2, +2.5 or less than +2.5, +3 or less than +3, +3.5 or less than +3.5, +4 or less than +4, +4.5 or less than +4.5, +5 or less than +5, +5.5 or less than +5.5, +6 or less than +6, +6.5 or less than +6.5, +7 or less than +7, +7.5 or less than +7.5, +8 or less than +8, +8.5 or less than +8.5, +9 or less than +9.5, +10 or less than +10, +11 or less than +11, +12 or less than +12, +13 or less than +13, +14 or less than +14, +15 or less than +15, +16 or less than +16, +17 or less than +17, +18 or less than +18, +19 or less than +19, +20 or less than +20, +21 or less than +21, +22 or less than +22, +23 or less than +23, +24 or less than +24, +25 or less than +25, +26 or less than +26, +27 or less than +27, +28 or less than +28, +29 or less than +29, or +30 or less than +30. In some embodiments, the peptide has a negative net charge at neutral pH, where the net charge is −0.5 or more than −0.5, −1 or more than −1, −1.5 or more than −1.5, −2 or more than −2, −2.5 or more than −2.5, −3 or more than −3, −3.5 or more than −3.5, −4 or more than −4, −4.5 or more than −4.5, −5 or more than −5, −5.5 or more than −5.5, −6 or more than −6, −6.5 or more than −6.5, −7 or more than −7, −7.5 or more than −7.5, −8 or more than −8, −8.5 or more than −8.5, −9 or more than −9.5, −10 or more than −10, −11 or more than −11, −12 or more than −12, −13 or more than −13, −14 or more than −14, −15 or more than −15, −16 or more than −16, −17 or more than −17, −18 or more than −18, −19 or more than −19, −20 or more than −20, −21 or more than −21, −22 or more than −22, −23 or more than −23, −24 or more than −24, −25 or more than −25, −26 or more than −26, −27 or more than −27, −28 or more than −28, −29 or more than −29, or −30 or more than −30.

In various embodiments, the peptides of the present disclosure comprise positively charged amino acid residues. In some embodiments, the peptide has at least 1 positively charged residue, at least 2 positively charged residues, at least 3 positively charged residues, at least 4 positively charged residues, at least 5 positively charged residues, at least 6 positively charged residues, at least 7 positively charged residues, at least 8 positively charged residues, at least 9 positively charged residues, at least 10 positively charged residues, at least 11 positively charged residues, at least 12 positively charged residues , at least 13 positively charged residues, at least 14 positively charged residues, at least 15 positively charged residues, at least 16 positively charged residues, or at least 17 positively charged residues. While the positively charged residues can be selected from any positively charged amino acid residues, in certain embodiments, the positively charged residues are either K, or R or a combination of K and R.

In various embodiments, the peptides of the present disclosure comprise negative amino acid residues. In some embodiments, the peptide has 1 or fewer negative amino acid residues, 2 or fewer negative amino acid residues, 3 or fewer negative amino acid residues, or 4 or fewer negative amino acid residues, 5 or fewer negative amino acid residues, 6 or fewer negative amino acid residues, 7 or fewer negative amino acid residues, 8 or fewer negative amino acid residues, 9 or fewer negative amino acid residues, or 10 or fewer negative amino acid residues. While negative amino acid residues can be selected from any negative charged amino acid residues, in certain embodiments, the negative amino acid residues are either E, or D or a combination of both E and D.

In various embodiments, the peptides of the present disclosure comprise neutral amino acid residues. In some embodiments, the peptide has 1 or fewer neutral amino acid residues, 2 or fewer neutral amino acid residues, 3 or fewer neutral amino acid residues, 4 or fewer neutral amino acid residues, 5 or fewer neutral amino acid residues, 6 or fewer neutral amino acid residues, 7 or fewer neutral amino acid residues, 8 or fewer neutral amino acid residues, 9 or fewer neutral amino acid residues, 10 or fewer neutral amino acid residues, 15 or fewer neutral amino acid residues, 20 or fewer neutral amino acid residues, 25 or fewer neutral amino acid residues, 30 or fewer neutral amino acid residues, 35 or fewer neutral amino acid residues, 40 or fewer neutral amino acid residues, or 60 or fewer neutral amino acid residues. In some embodiments, the peptides are members of the pfam00451:toxin_2 family. The pfam00451:toxin_2 structural class family can include a peptide of any one of IKCSESYQCFPVCKSRFGKTNGRCVNGFCDCF (SEQ ID NO: 577); VKCSSPQQCLKPCKAAFGISAGGKCINGKCKCY (SEQ ID NO: 578); VSCSASSQCWPVCKKLFGTYRGKCMNSKCRCY (SEQ ID NO: 579); ESCTASNQCWSICKRLHNTNRGKCMNKKCRCY (SEQ ID NO: 580); VSCTTSKECWSVCEKLYNTSRGKCMNKKCRCY (SEQ ID NO: 581); MRCKSSKECLVKCKQATGRPNGKCMNRKCKCY (SEQ ID NO: 582); IKCTLSKDCYSPCKKETGCPRAKCINRNCKCY (SEQ ID NO: 583); IRCSGSRDCYSPCMKQTGCPNAKCINKSCKCY (SEQ ID NO: 584); IRCSGTRECYAPCQKLTGCLNAKCMNKACKCY (SEQ ID NO: 585); ISCTNPKQCYPHCKKETGYPNAKCMNRKCKCF (SEQ ID NO: 586); ASCRTPKDCADPCRKETGCPYGKCMNRKCKCN (SEQ ID NO: 587); TSCISPKQCTEPCRAKGCKHGKCMNRKCHCM (SEQ ID NO: 588); KECTGPQHCTNFCRKN-KCTHGKCMNRKCKCF (SEQ ID NO: 589); IKCRTPKDCADPCRKQTGCPHAKCMNKTCRCH (SEQ ID NO: 590); VKCTTSKECWPPCKAATGKAAGKCMNKKCKCQ (SEQ ID NO: 591); LECGASRECYDPCFKAFGRAHGKCMNNKCRCY (SEQ ID NO: 592); EKCFATSQCWTPCKKAIGSLQSKCMNGKCKCY (SEQ ID NO: 593); VRCYASRECWEPCRRVTGSAQAKCQNNQCRCY (SEQ ID NO: 594); VKCSASRECWVACKKVTGSGQGKCQNNQCRCY (SEQ ID NO: 595); VKCISSQECWIACKKVTGRFEGKCQNRQCRCY (SEQ ID NO: 596); VRCYDSRQCWIACKKVTGSTQGKCQNKQCRCY (SEQ ID NO: 597); VDCTVSKECWAPCKAAFGVDRGKCMGKKCKCY (SEQ ID NO: 598); AKCRGSPECLPKCKEAIGKAAGKCMNGKCKCY (SEQ ID NO: 599); KKCQGGSCASVCRRVIGVAAGKCINGRCVCY (SEQ ID NO: 600); KKCSNTSQCYKTCEKVVGVAAGKCMNGKCICY (SEQ ID NO: 601); VKCSGSSKCVKICIDRYNTRGAKCINGRCTCY (SEQ ID NO: 602); NRCNNSSECIPHCIRIFGTRAAKCINRKCYCY (SEQ ID NO: 603); KECNGSSECYSHCEGITGKRSGKCINKKCYCY (SEQ ID NO: 604); AFCNLRRCELSCRSLGLLGKCIGEECKCV (SEQ ID NO: 605); AVCNLKRCQLSCRSLGLLGKCIGDKCECV (SEQ ID NO: 606);

AACYSS-DCRVKCVAMGFSSGKCINSKCKCY (SEQ ID NO: 607); AICATDADCSRKCPGNPPCRNGFCACT (SEQ ID NO: 608); TECQIKNDCQRYCQSVKECKYGKCYCN (SEQ ID NO: 609); TQCQSVRDCQQYCLTPDRCSYGTCYCK (SEQ ID NO: 610); VSCRYGSDCAEPCKRLKCLLPSKCINGKCTCY (SEQ ID NO: 611); IKCRYPADCHIMCRKVTGRAEGKCMNGKCTCY (SEQ ID NO: 612); IKCSSSSSCYEPCRGVTGRAHGKCMNGRCTCY (SEQ ID NO: 613); VKCTGSKQCLPACKAAVGKAAGKCMNGKCKCY (SEQ ID NO: 614); VSCKHSGQCIKPCKDA-GMRFGKCMNRKCDCT (SEQ ID NO: 615); VKCRGSPQCIQPCRDA-GMRFGKCMNGKCHCT (SEQ ID NO: 616); VKCTSPKQCLPPCKAQFGIRAGAKCMNGKCKCY (SEQ ID NO: 617); VKCTSPKQCSKPCKELYGSSAGAKCMNGKCKCY (SEQ ID NO: 618); VKCTSPKQCLPPCKEIYGRHAGAKCMNGKCHCS (SEQ ID NO: 619); VKCTGSKQCWPVCKQMFGKPNGKCMNGKCRCY (SEQ ID NO: 620); VKCRGSRDCLDPCKKAGMRFGKCINSKCHCT (SEQ ID NO: 621); VRCVTDDDCFRKCPGNPSCKRGFCACK (SEQ ID NO: 622); or VPCNNSRPCVPVCIREVNNKNGKCSNGKCLCY (SEQ ID NO: 623). A kidney homing peptide of this disclosure can be a variant of any peptide members of the pfam00451:toxin_2 family. In some embodiments, an exemplary kidney homing peptide of this disclosure that is a variant of the pfam00451:toxin_2 structural class family is a peptide of SEQ ID NO: 45. In other embodiments, an exemplary kidney homing peptide of this disclosure that is a variant of the pfam00451:toxin_2 structural class family is a peptide of SEQ ID NO: 132. In other embodiments, the variant peptides are at least 30% identical to a peptide of the structural class pfam00451:toxin_2 family. In some embodiments, the variant peptides are 30%, 40%, 50%, 60%, 80%, 90% or 95% identical to a peptide of the structural class pfam00451:toxin_2 family. In some embodiments, the variant peptides are at least 30%, at least 40%, at least 50%, at least 60%, at least 80%, at least 90% or at least 95% identical to a peptide of the structural class pfam00451:toxin_2 family.

In some embodiments, kidney homing peptides are family members of the sequences

(SEQ ID NO: 538) GSXVXXXVKCXGSKQCXXPCKRXXGXRXGKCINKKXCKCYXXX or (SEQ ID NO: 558) XVXXXVKCXGSKQCXXPCKRXXGXRXGKCINKKXCKCYXXX, wherein X can be any amino acid, amino acid analogue ,or null, in which these sequences are based on the most common elements found in the following sequences: GSGVPINVKCRGSRDCLDPCKKA-GMRFGKCINSK-CHCTP-- (SEQ ID NO: 45), GS-VRIPVSCKHSGQCLKPCKDA-GMRFGKCMNGK-CDCTPK- (SEQ ID NO: 44), GSQVQTNVKCQGGS-CASVCRREIGVAAGKCINGK-CVCYRN- (SEQ ID NO: 48), GS-----ISCTGSKQCYDPCKRKTGCPNAKCMNKS-CKCYGCG (SEQ ID NO: 47), GSEV---IRCSGSKQCYGPCKQQTGCTNSKCMNKV-CKCYGCG (SEQ ID NO: 49), GSAVCVYRT------CDKDCKRR-GYRSGKCINNA-CKCYPYG (SEQ ID NO: 46), GS----GIVC---KVCKIICGMQ-GKKVNICKAPIKCKCKKG- (SEQ ID NO: 42), and GSQIYTSKECNGSSECYSHCEGITGKRSGKCINKK-CYCYR-- (SEQ ID NO: 51), where the following residues may be independently interchanged in the sequences: K and R; M, I, L, and V; G and A; S and T; Q and N; and X can independently be any number of any amino acid or no amino acid. The N-terminal GS sequence can be included or excluded between the peptides of the present disclosure.

In other embodiments, peptides are family members of the sequences GSXXXGCVXXXXKCRPGXKXCCXPXKRCSRRFGXXXXKKCKXXXXXX (SEQ ID NO: 539) or XXXGCVXXXXKCRPGXKXCCXPXKRCSRRFGXXXXKKCKXXXXXX (SEQ ID NO: 559), in which the sequence is based on the most common elements found in the following sequences: GS---ACKGVFDACTPGKNECC-PNRVCSDK-H----KWCKWKL--- (SEQ ID NO: 50), GS---GCLEFWWKCNPNDDKCCRPKLKCSKLF-----KLCNFSFG-- (SEQ ID NO: 52), GSSEKDCIKHLQRCR-ENKDCC--SKKCSRR-GTNPEKRCR------ (SEQ ID NO: 43), and GS---GCFGY--KCDYY-KGCCSGYV-CSPTW-----KWCVRPGPGR (SEQ ID NO: 54), where the following residues may be independently interchanged in the sequences: K and R; M, I, L, and V; G and A; S and T; Q and N; and X can independently be any number of any amino acid or no amino acid. The N-terminal GS sequence can be included or excluded between the peptides of the present disclosure.

In some embodiments, a peptide comprises the sequence GSGVX¹IX²X³KCX⁴GSKQCX⁵DPCKX⁶X⁷X⁸GX⁹RX¹⁰GKCX¹¹NKKCKCX¹²X¹³X¹⁴X¹⁵ (SEQ ID NO: 530) or GVX¹IX²X³KCX⁴GSKQCX⁵DPCKX⁶X⁷X⁸GX⁹RX¹⁰GKCX¹¹NKKCKCX¹²X¹³X¹⁴X¹⁵ (SEQ ID NO: 550), wherein X¹, X², X³, X⁴, X⁵, X⁶, X⁷, X⁸, X⁹, X¹⁰, X¹¹, X¹², X¹³, X¹⁴ and X¹⁵ are each individually any amino acid or amino acid analogue or null. In some cases, the peptide comprises the sequence GSGVX¹IX²X³KCX⁴GSKQCX⁵DPCKX⁶X⁷X⁸GX⁹RX¹⁰GKCX¹¹NKKCKCX¹²X¹³X¹⁴X¹⁵ (SEQ ID NO: 531) or GVX¹IX²X³KCX⁴GSKQCX⁵DPCKX⁶X⁷X⁸GX⁹RX¹⁰GKCX¹¹NKKCKCX¹²X¹³X¹⁴X¹⁵ (SEQ ID NO: 551), where X¹ is selected from P or R, wherein X² is selected from P or N, wherein X³ is selected from V or I, wherein X⁴ is selected from S, T, R or K, wherein X⁵ is selected from Y or L, wherein X⁶ is selected from Q, R or K, wherein X⁷ is selected from A, K or R, wherein X⁸ is selected from T or A, wherein X⁹ is selected from C or M, wherein X¹⁰ is selected from F or N, wherein X¹¹ is selected from M or I, wherein X¹² is selected from Y or T, wherein X¹³ is selected from G or P, wherein X¹⁴ is selected from C or null, and wherein X¹⁵ is selected from G or null.

In some embodiments, a peptide comprises the sequence GSX¹X²X³X⁴IX⁵CX⁶GSKQCYX⁷PCKX⁸X⁹TGCX¹⁰X¹¹X¹²KCX¹³X¹⁴KX¹⁵CKCYGCG (SEQ ID NO: 532) or X¹X²X³X⁴IX⁵CX⁶GSKQCYX⁷PCKX⁸X⁹TGCX¹⁰X¹¹X¹²KCX¹³X¹⁴KX¹⁵CKCYGCG (SEQ ID NO: 552), wherein X¹, X², X³, X⁴, X⁵, X⁶, X⁷, X⁸, X⁹, X¹⁰, X¹¹, x¹², X¹³, X¹⁴, and X¹⁵ are each individually any amino acid or amino acid analogue or null. In some cases, the peptide comprises the sequence GSX¹X²X³X⁴IX⁵CX⁶GSKQCYX⁷PCKX⁸X⁹TGCX¹⁰X¹¹X¹²KCX¹³X¹⁴KX¹⁵CKCYGCG (SEQ ID NO: 533) or X¹X²X³X⁴IX⁵CX⁶GSKQCYX⁷PCKX⁸X⁹X¹⁰X¹¹X¹²KCX¹³X¹⁴KX¹⁵CKCYGCG (SEQ ID NO: 553), where X¹ is selected from G or null, wherein X² is selected from S or null, wherein X³ is selected from E, G or null, wherein X⁴ is selected from V, S, or null, wherein X⁵ is selected from R or S, wherein X⁶ is selected from S or T, wherein X⁷ is selected from G or D, wherein X⁸ is selected from Q or R, wherein X⁹ is selected from Q or K, wherein X¹⁰ is selected from T or P, wherein X¹¹ is selected from N or Q, wherein X¹² is selected from S or A, wherein X¹³ is selected from M or L, wherein X¹⁴ is selected from N or Q, and wherein X¹⁵ is selected from V or S.

In some embodiments, a peptide comprises the sequence GSX¹X²X³VX⁴IX⁵VX⁶CX⁷X⁸SX⁹X¹⁰CLX¹¹PCKX¹²AGMRFGKCX¹³NX¹⁴KCX¹⁵CTPX¹⁶ (SEQ ID NO: 534) or X¹X²X³VX⁴IX⁵VX⁶CX⁷X⁸SX⁹X¹⁰CLX¹¹PCKX¹²AGMRFGKCX¹³NX¹⁴KCX¹⁵CTPX¹⁶ (SEQ ID NO: 554)_(, wherein X) ¹, X², X³, X⁴, X⁵, X⁶, X⁷, X⁸, X⁹, X¹⁰, X¹¹, X¹², X¹³, X¹⁴, X¹⁵, X¹⁶ are each individually any amino acid or amino acid analogue or null. In some cases, the peptide comprises the sequence GSX¹X²X³VX⁴IX⁵VX⁶CX⁷X⁸SX⁹X¹⁰CLX¹¹PCKX¹²AGMRFGKCX¹³NX¹⁴KCX¹⁵CTPX¹⁶ (SEQ ID NO: 535) or X¹X²X³VX⁴IX⁵VX⁶CX⁷X⁸SX⁹X¹⁰CLX¹¹PCKX¹²AGMRFGKCX¹³NX¹⁴KCX¹⁵CTPX¹⁶ (SEQ ID NO: 555), where X¹ is selected from G or null, wherein X² is selected from G, S or null, wherein X³ is selected from G, S or null, wherein X⁴ is selected from P or R, wherein X⁵ is selected from N or P, wherein X⁶ is selected from K or S, wherein X⁷ is selected from R or K, wherein X⁸ is selected from G or H, wherein X⁹ is selected from R or G, wherein X¹⁰ is selected from D or Q, wherein X¹¹ is selected from D or K, wherein X¹² is selected from K or D, wherein X¹³ is selected from I or M, wherein X¹⁴ is selected from S or G, wherein X¹⁵ is selected from H or D, and wherein X¹⁶ is selected from K or null.

In some embodiments, a peptide comprises the sequence GSXVXVKCXGSKQCXPCKRXGXRXGKCINKKXCKCYX (SEQ ID NO: 536) or GSXGCVXKCRPGXKXCCXPXKRCSRRFGXKKCKX (SEQ ID NO: 537), wherein each letter is each individually any amino acid or amino acid analogue and where X is no amino acid or a 1-10 amino acid long peptide fragment wherein each amino acid within such peptide fragment can in each case be any amino acid or amino acid analogue. In some embodiments, a peptide comprises the sequence XVXVKCXGSKQCXPCKRXGXRXGKCINKKXCKCYX (SEQ ID NO: 556) or XGCVXKCRPGXKXCCXPXKRCSRRFGXKKCKX (SEQ ID NO: 557), wherein each letter is each individually any amino acid or amino acid analogue and where X is no amino acid or a 1-10 amino acid long peptide fragment wherein each amino acid within such peptide fragment can in each case be any amino acid or amino acid analogue.

In some embodiments, a peptide comprises the sequence GSGVX¹IX²X³RCX⁴GSRQCX⁵DPCRX⁶X⁷X⁸GX⁹RX¹⁰GRCX¹¹NRRCRCX¹²X¹³X¹⁴X¹⁵ (SEQ ID NO: 540) or GVX¹IX²X³RCX⁴GSRQCX⁵DPCRX⁶X⁷X⁸GX⁹RX¹⁰GRCX¹¹NRRCRCX¹²X¹³X¹⁴X¹⁵ (SEQ ID NO: 560), wherein X¹, X², X³, X⁴, X⁵, X⁶, X⁷, X⁸, X⁹, X¹⁰, X¹¹, X¹², X¹³, X¹⁴ and X¹⁵ are each individually any amino acid or amino acid analogue or null. In some cases, the peptide comprises the sequence GSGVX¹IX²X³RCX⁴GSRQCX⁵DPCRX⁶X⁷X⁸GX⁹RX¹⁰GRCX¹¹NRRCRCX¹²X¹³X¹⁴X¹⁵ (SEQ ID NO: 541) or GVX¹IX²X³RCX⁴GSRQCX⁵DPCRX⁶X⁷X⁸GX⁹RX¹⁰GRCX¹¹NRRCRCX¹²X¹³X¹⁴X¹⁵ (SEQ ID NO: 561), where X¹ is selected from P or R, wherein X² is selected from P or N, wherein X³ is selected from V or I, wherein X⁴ is selected from S, T, R or K, wherein X⁵ is selected from Y or L, wherein X⁶ is selected from Q, R or K, wherein X⁷ is selected from A, K or R, wherein X⁸ is selected from T or A, wherein X⁹ is selected from C or M, wherein X¹⁰ is selected from F or N, wherein X¹¹ is selected from M or I, wherein X¹² is selected from Y or T, wherein X¹³ is selected from G or P, wherein X¹⁴ is selected from C or null, and wherein X¹⁵ is selected from G or null.

In some embodiments, a peptide comprises the sequence GSX¹X²X³X⁴IX⁵CX⁶GSRQCYX⁷PCRX⁸X⁹TGCX₁₀X¹¹X¹²RCX¹³X¹⁴RX¹⁵CRCYGCG (SEQ ID NO: 542) or X¹X²X³X⁴IX⁵CX⁶GSRQCYX⁷PCRX⁸X⁹TGCX¹⁰X¹¹X¹²RCX¹³X¹⁴RX¹⁵CRCYGCG (SEQ ID NO: 562), wherein X¹, X², X³, X⁴, X⁵, X⁶, X⁷, X⁸, X⁹, X¹⁰, X¹¹, X¹², X¹³, X¹⁴, and X¹⁵ are each individually any amino acid or amino acid analogue or null. In some cases, the peptide comprises the sequence GSX¹X²X³X⁴IX⁵CX⁶GSRQCYX⁷PCRX⁸X⁹TGCX¹⁰X¹¹X¹²RCX¹³X¹⁴RX¹⁵CRCYGCG, (SEQ ID NO: 543) or X¹X²X³X⁴IX⁵CX⁶GSRQCYX⁷PCRX⁸X⁹TGCX¹⁰X¹¹X¹²RCX¹³X¹⁴RX¹⁵CRCYGCG (SEQ ID NO: 563), where X¹ is selected from G or null, wherein X² is selected from S or null, wherein X³ is selected from E, G or null, wherein X⁴ is selected from V, S, or null, wherein X⁵ is selected from R or S, wherein X⁶ is selected from S or T, wherein X⁷ is selected from G or D, wherein X⁸ is selected from Q or R, wherein X⁹ is selected from Q, R, or K, wherein X¹⁰ is selected from T or P, wherein X¹¹ is selected from N or Q, wherein X¹² is selected from S or A, wherein X¹³ is selected from M or L, wherein X¹⁴ is selected from N or Q, and wherein X¹⁵ is selected from V or S.

In some embodiments, a peptide comprises the sequence GSX¹X²X³VX⁴IX⁵VX⁶CX⁷X⁸SX⁹X¹⁰CLX¹¹PCRX¹²AGMRFGRCX¹³NX¹⁴RCX¹⁵CTPX¹⁶ (SEQ ID NO: 544) or X¹X²X³VX⁴IX⁵VX⁶CX⁷X⁸SX⁹X¹⁰CLX¹¹PCRX¹²AGMRFGRCX¹³NX¹⁴RCX¹⁵CTPX¹⁶ (SEQ ID NO: 564), wherein X¹, X², X³, X⁴, X⁵, X⁶, X⁷, X⁸, X⁹, X¹⁰, X¹¹, X¹², X¹³, X¹⁴, X¹⁵, X¹⁶ are each individually any amino acid or amino acid analogue or null. In some cases, the peptide comprises the sequence GSX¹X²X³VX⁴IX⁵VX⁶CX⁷X⁸SX⁹X¹⁰CLX¹¹PCRX¹²AGMRFGRCX¹³NX¹⁴RCX¹⁵CTPX¹⁶ (SEQ ID NO: 545) or X¹X²X³VX⁴IX⁵VX⁶CX⁷X⁸SX⁹X¹⁰CLX¹¹PCRX¹²AGMRFGRCX¹³NX¹⁴RCX¹⁵CTPX¹⁶ (SEQ ID NO: 565), where X¹ is selected from G or null, wherein X² is selected from G, S or null, wherein X³ is selected from G, S or null, wherein X⁴ is selected from P or R, wherein X⁵ is selected from N or P, wherein X⁶ is selected from R, K or S, wherein X⁷ is selected from R or K, wherein X⁸ is selected from G or H, wherein X⁹ is selected from R or G, wherein X¹⁰ is selected from D or Q, wherein X¹¹ is selected from D, R, or K, wherein X¹² is selected from K, R, or D, wherein X¹³ is selected from I or M, wherein X¹⁴ is selected from S or G, wherein X¹⁵ is selected from H or D, and wherein X¹⁶ is selected from K, R, or null.

In some embodiments, a peptide comprises the sequence GSXVXVRCXGSRQCXPCRRXGXRXGRCINRRXCRCYX (SEQ ID NO: 546) or GSXGCVXRCRPGXRXCCXPXRRCSRRFGXRRCRX (SEQ ID NO: 547), wherein each letter is each individually any amino acid or amino acid analogue and where X is no amino acid or a 1-10 amino acid long peptide fragment wherein each amino acid within such peptide fragment can in each case be any amino acid or amino acid analogue. In some embodiments, a peptide comprises the sequence XVXVRCXGSRQCXPCRRXGXRXGRCINRRXCRCYX (SEQ ID NO: 566) or XGCVXRCRPGXRXCCXPXRRCSRRFGXRRCRX (SEQ ID NO: 567), wherein each letter is each individually any amino acid or amino acid analogue and where X is no amino acid or a 1-10 amino acid long peptide fragment wherein each amino acid within such peptide fragment can in each case be any amino acid or amino acid analogue.

In some embodiments, a peptide comprises the sequence GSXVXXXVRCXGSRQCXXPCRRXXGXRXGRCINRRXCRCYXXX (SEQ ID NO: 548), XVXXXVRCXGSRQCXXPCRRXXGXRXGRCINRRXCRCYXXX (SEQ ID NO: 568), GSXXXGCVXXXXRCRPGXRXCCXPXRRCSRRFGXXXXRRCRXXXXXX (SEQ ID NO: 549), or XXXGCVXXXXRCRPGXRXCCXPXRRCSRRFGXXXXRRCRXXXXXX (SEQ ID NO: 569) wherein X is no amino acid or any amino acid analogue.

In some embodiments, a peptide comprises the one or more of the following peptide fragments: GKCINKKCKC (SEQ ID NO: 356); KCIN (SEQ ID NO: 357); KKCK (SEQ ID NO: 358); PCKR (SEQ ID NO: 359); KRCSRR (SEQ ID NO: 360); KQC (SEQ ID NO: 361); GRCINRRCRC (SEQ ID NO: 442); RCIN (SEQ ID NO: 443); RRCR (SEQ ID NO: 444); PCRR (SEQ ID NO: 445); RRCSRR (SEQ ID NO: 446); RQC (SEQ ID NO: 447); PCKK (SEQ ID NO: 449), and KKCSKK (SEQ ID NO: 450).

TABLE 1 lists some exemplary peptides according to the present disclosure.

TABLE 1 Exemplary Amino Acid Sequences SEQ ID NO Amino Acid Sequence SEQ ID NO: 1 GSDCLPHLRRCRADNDCCGRRCRRRGTNAERRCR SEQ ID NO: 2 GSDCKYKFENWGACDGGTGTKVRQGTLKKARYNAQCQETIRVTKPC SEQ ID NO: 3 GSDCKYKFENWGACDGGTGTKVRQGTLKKARYNAQCQETIRVTKPC TPKTKAKAKAKKGKGKD SEQ ID NO: 4 GSSCEPGRTFRDRCNTCRCGADGRSAACTLRACPNQ SEQ ID NO: 5 GSQFTNVSCTTSRECWSVCQRLHNTSRGRCMNRRCRCYS SEQ ID NO: 6 GSMCMPCFTTDHQMARRCDDCCGGRGRGRCYGPQCLCR SEQ ID NO: 7 GSISIGIKCSPSIDLCEGQCRIRKYFTGYCSGDTCHCSG SEQ ID NO: 8 GSSCAKPRENCNRMNILCCRGECVCPTFGDCFCYGD SEQ ID NO: 9 GSNFKVEGACSKPCRKYCIDKGARNGKCINGRCHCYY SEQ ID NO: 10 GSDRDSCIDKSRCSKYGYYQECQDCCKKAGHNGGTCMFFKCKCA SEQ ID NO: 11 GSQFCGTNGKPCVNGQCCGALRCVVTYHYADGVCLKMNP SEQ ID NO: 12 GSRPTDIKCSASYQCFPVCKSRFGKTNGRCVNGLCDCF SEQ ID NO: 13 GSNCAGYMRECKEKLCCSGYVCSSRWKWCVLPAPWRR SEQ ID NO: 14 GSQFTDVKCTGSKQCWPVCKQMFGKPNGKCMNGKCRCYS SEQ ID NO: 15 GSQIDTNVKCSGSSKCVKICIDRYNTRGAKCINGRCTCYP SEQ ID NO: 16 GSAEIIRCSGTRECYAPCQKLTGCLNAKCMNKACKCYGCV SEQ ID NO: 17 GSSDYCSNDFCFFSCRRDRCARGDCENGKCVCKNCHLN SEQ ID NO: 18 GSCIGEGVPCDENDPRCCFGLVCLKPTLHGIWYKSYYCYKK SEQ ID NO: 19 GSSCAKPGEMCMRIKCCDGQCGCNRGTGRCFCK SEQ ID NO: 20 GSACLAEYQKCEGSTVPCCPGLSCSAGRFRKTKLCTK SEQ ID NO: 21 GSVVIGQRCYRSPDCYSACKKLVGKATGKCTNGRCDC SEQ ID NO: 22 GSACQFWSCNSSCISRGYRQGYCWGIQYKYCQCQ SEQ ID NO: 23 GSRCPPCFTTNPNMEADCRKCCGGRGYCASYQCICPGG SEQ ID NO: 24 GSQVSTNKKCSNTSQCYKTCEKVVGVAAGKCMNGKCICYP SEQ ID NO: 25 GSECLEIFKACNPSNDQCCKSSKLVCSRKTRWCKYQIG SEQ ID NO: 26 GSQDKCKKVYENYPVSKCQLANQCNYDCKLDKHARSGECFYDEKR NLQCICDYCEY SEQ ID NO: 27 GSGHACYRNCWREGNDEETCKERC SEQ ID NO: 28 GSMCMPCFTTDTQMQERCDRCCGGGGRGRCWGPQCLCI SEQ ID NO: 29 GSMCMPCFTTEQRMAIICDDCCGGFGRGRCYGPQCLCR SEQ ID NO: 30 GSICIPCFTTDHQIARRCDDCCGGRGRGRCYGPQCICR SEQ ID NO: 31 GSRCQLQGFNCVVRSYGLPTIPCCRGLTCRSYFPGSTYGRCQRY SEQ ID NO: 32 GSSFGLCRLRRGFCARGRCRFPSIPIGRCSRFVQCCRRVW SEQ ID NO: 33 GSSCEPGTTFRDRCNTCRCGSDGRSAACTLRACPQ SEQ ID NO: 34 GSSCTPGTTFRDRCNTCRCSSNGRSAACTLRACPPGSY SEQ ID NO: 35 GSSCTPGTTFRNRCNTCRCGSNGRSASCTLMACPPGSY SEQ ID NO: 36 GSSCTPGATFRNRCNTCRCGSNGRSASCTLMACPPGSY SEQ ID NO: 37 GSSCQPGTTYQRGCNTCRCLEDGQTEACTLRLC SEQ ID NO: 38 GSSCTPGATYREGCNICRCRSDGRSGACTRRICPVDSN SEQ ID NO: 39 GSSCQPGTTFRRDCNTCVCNRDGTNAACTLRACL SEQ ID NO: 40 GGYSRCQLQGFNCVVRSYGLPTIPCCRGLTCRSYFPGSTYGRCQRY SEQ ID NO: 41 GSSCARPRENCNRMNILCCRGECVCPTFGDCFCYGD SEQ ID NO: 42 GSGIVCKVCKIICGMQGKKVNICKAPIKCKCKKG SEQ ID NO: 43 GSSEKDCIKHLQRCRENKDCCSKKCSRRGTNPEKRCR SEQ ID NO: 44 GSVRIPVSCKHSGQCLKPCKDAGMRFGKCMNGKCDCTPK SEQ ID NO: 45 GSGVPINVKCRGSRDCLDPCKKAGMRFGKCINSKCHCTP SEQ ID NO: 46 GSAVCVYRTCDKDCKRRGYRSGKCINNACKCYPYG SEQ ID NO: 47 GSISCTGSKQCYDPCKRKTGCPNAKCMNKSCKCYGCG SEQ ID NO: 48 GSQVQTNVKCQGGSCASVCRREIGVAAGKCINGKCVCYRN SEQ ID NO: 49 GSEVIRCSGSKQCYGPCKQQTGCTNSKCMNKVCKCYGCG SEQ ID NO: 50 GSACKGVFDACTPGKNECCPNRVCSDKHKWCKWKL SEQ ID NO: 51 GSQIYTSKECNGSSECYSHCEGITGKRSGKCINKKCYCYR SEQ ID NO: 52 GSGCLEFWWKCNPNDDKCCRPKLKCSKLFKLCNFSFG SEQ ID NO: 53 GSDCVRFWGKCSQTSDCCPHLACKSKWPRNICVWDGSVG SEQ ID NO: 54 GSGCFGYKCDYYKGCCSGYVCSPTWKWCVRPGPGR SEQ ID NO: 55 GSMNAKFILLLVLTTMMLLPDTKGAEVIRCSGSKQCYGPCKQQTGCT NSKCMNKVCKCYGCG SEQ ID NO: 56 GSMNAKLIYLLLVVTTMTLMFDTAQAVDIMCSGPKQCYGPCKKETG CPNAKCMNRRCKCYGCV SEQ ID NO: 57 GSMNAKLIYLLLVVTTMMLTFDTTQAGDIKCSGTRQCWGPCKKQTT CTNSKCMNGKCKCYGCVG SEQ ID NO: 58 GSMNTKFIFLLLVVTNTMMLFDTKPVEGISCTGSKQCYDPCKRKTGC PNAKCMNKSCKCYGCG SEQ ID NO: 59 GSGVPINVKCSGSRDCLEPCKKAGMRFGKCINRKCHCTPK SEQ ID NO: 60 GSGVPINVKCTGSPQCLKPCKDAGMRFGKCINGKCHCTPK SEQ ID NO: 61 GSGVIINVKCKISRQCLEPCKKAGMRFGKCMNGKCHCTPK SEQ ID NO: 62 GSGVPINVKCRGSPQCIQPCRDAGMRFGKCMNGKCHCTPQ SEQ ID NO: 63 GSGVEINVKCTGSHQCIKPCKDAGMRFGKCINRKCHCTPK SEQ ID NO: 64 GSGVEINVKCSGSPQCLKPCKDAGMRFGKCMNRKCHCTPK SEQ ID NO: 65 GSGVPTDVKCRGSPQCIQPCKDAGMRFGKCMNGKCHCTPK SEQ ID NO: 66 GSGVPINVSCTGSPQCIKPCKDAGMRFGKCMNRKCHCTPK SEQ ID NO: 67 GSGVPINVPCTGSPQCIKPCKDAGMRFGKCMNRKCHCTPK SEQ ID NO: 68 GSVGINVKCKHSGQCLKPCKDAGMRFGKCINGKCDCTPK SEQ ID NO: 69 GSVGINVKCKHSGQCLKPCKDAGMRFGKCMNGKCDCTPK SEQ ID NO: 70 GSVGIPVSCKHSGQCIKPCKDAGMRFGKCMNRKCDCTPK SEQ ID NO: 71 GSRKGCFKEGHSCPKTAPCCRPLVCKGPSPNTKKCTRP SEQ ID NO: 72 GSSFCIPFKPCKSDENCCKKFKCKTTGIVKLCRW SEQ ID NO: 73 GSLKGCLPRNRFCNALSGPRCCSGLRCKELSIWASKCL SEQ ID NO: 74 GSGNYCLRGRCLPGGRKCCNGRPCECFAKICSCKPK SEQ ID NO: 75 GSTVKCGGCNRKCCPGGCRSGKCINGKCQCY SEQ ID NO: 76 GSGCMKEYCAGQCRGKVSQDYCLKHCKCIPR SEQ ID NO: 77 GSACLGFGEKCNPSNDKCCKSSSLVCSQKHKWCKYG SEQ ID NO: 78 GSRGGCLPHNRFCNALSGPRCCSGLRCKELSIRDSRCLG SEQ ID NO: 79 GSRGGCLPRNKFCNPSSGPRCCSGLTCKELNIWASKCL SEQ ID NO: 80 GSQRSCAKPGDMCMGIKCCDGQCGCNRGTGRCFCK SEQ ID NO: 81 GSARGCADAYKSCNHPRTCCDGYNGYKRACICSGSNCKCKKS SEQ ID NO: 82 GSRGGCLPHNRFCNALSGPRCCSGLRCKELSIWDSRCLG SEQ ID NO: 83 GSRGGCLPHNRFCNALSGPRCCSGLKCKELSIYDSRCLG SEQ ID NO: 84 GSRGGCLPHNRFCNALSGPRCCSRLKCKELSIWDSRCLG SEQ ID NO: 85 GSRGGCLPHNRFCNALTGPRCCSRLRCKELSIWDSICLG SEQ ID NO: 86 GSSCADAYKSCDSLKCCNNRTCMCSMIGTNCTCRKK SEQ ID NO: 87 GSERRCLPAGKTCVRGPMRVPCCGSCSQNKCT SEQ ID NO: 88 GSLCSREGEFCYKLRKCCAGFYCKAFVLHCYRN SEQ ID NO: 89 GSACGSCRKKCKGSGKCINGRCKCY SEQ ID NO: 90 GSACGSCRKKCKGPGKCINGRCKCY SEQ ID NO: 91 GSACQGYMRKCGRDKPPCCKKLECSKTWRWCVWN SEQ ID NO: 92 GSGRYCQKWMWTCDSKRACCEGLRCKLWCRKI SEQ ID NO: 93 GSNAKCRGSPECLPKCKEAIGKAAGKCMNGKCKCYP SEQ ID NO: 94 GSNVKCRGSKECLPACKAAVGKAAGKCMNGKCKCYP SEQ ID NO: 95 GSNVKCRGSPECLPKCKEAIGKSAGKCMNGKCKCYP SEQ ID NO: 96 GSNAKCRGSPECLPKCKQAIGKAAGKCMNGKCKCYP SEQ ID NO: 97 GSRGYCAEKGIKCHNIHCCSGLTCKCKGSSCVCRK SEQ ID NO: 98 GSERGCKLTFWKCKNKKECCGWNACALGICNIPR SEQ ID NO: 99 GSKKKCIAKDYGRCKWGGTPCCRGRGCICSIMGTNCECKPR SEQ ID NO: 100 GSGCKLTFWKCKNKKECCGWNACALGICMPR SEQ ID NO: 101 GSACKGLFVTCTPGKDECCPNHVCSSKHKWCKYK SEQ ID NO: 102 GSIACAPRGLLCFRDKECCKGLTCKGRFVNTWPTFCLV SEQ ID NO: 103 GSACAGLYKKCGKGVNTCCENRPCKCDLAMGNCICKKK SEQ ID NO: 104 GSFTCAISCDIKVNGKPCKGSGEKKCSGGWSCKFNVCVKV SEQ ID NO: 105 GSGFCAQKGIKCHDIECCTNLKCVREGSNRVCRKA SEQ ID NO: 106 GSCAKKRNWCGKNEDCCCPMKCIYAWYNQQGSCQSTITGLFKKC SEQ ID NO: 107 GSYCQKWMWTCDSARKCCEGLVCRLWCKKI SEQ ID NO: 108 GSRGGCLPHNKFCNALSGPRCCSGLKCKELTIWNTKCLE SEQ ID NO: 109 GSNVKCTGSKQCLPACKAAVGKAAGKCMNGKCKCYT SEQ ID NO: 110 GSQRSCAKPGEMCMRIKCCDGQCGCNRGTGRCFCK SEQ ID NO: 111 GSGCIPKHKRCTWSGPKCCNNISCHCNISGTLCKCRPG SEQ ID NO: 112 GSNYCVAKRCRPGGRQCCSGKPCACVGKVCKCPRD SEQ ID NO: 113 GSERGCSGAYKRCSSSQRCCEGRPCVCSAINSNCKCRKT SEQ ID NO: 114 GSRYCPRNPEACYNYCLRTGRPGGYCGGRSRITCFCFR SEQ ID NO: 115 GSQRSCAKPGEMCMGIKCCDGQCGCNRGTGRCFCK SEQ ID NO: 116 GSRRGCFKEGKWCPKSAPCCAPLKCKGPSIKQQKCVRE SEQ ID NO: 117 GSTVKCGGCNRKCCAGGCRSGKCINGKCQCYGR SEQ ID NO: 118 GSERRCEPSGKPCRPLMRIPCCGSCVRGKCA SEQ ID NO: 119 GSRGGCLPRNKFCNPSSGPRCCSGLTCKELNIWANKCL SEQ ID NO: 120 GSCAKKRNWCGKNEDCCCPMKCIYAWYNQQGSCQTTITGLFKKC SEQ ID NO: 127 GSVRIPVSCKHSGQCLKPCKDAGMRTGKCMNGKCDCTPK SEQ ID NO: 128 GSVKCTTSKDCWPPCKKVTGRA SEQ ID NO: 129 GSGIVCRVCRIICGMQGRRVNICRAPIRCRCRRG SEQ ID NO: 130 GSSERDCIRHLQRCRENRDCCSRRCSRRGTNPERRCR SEQ ID NO: 131 GSVRIPVSCRHSGQCLRPCRDAGMRFGRCMNGRCDCTPR SEQ ID NO: 132 GSGVPINVRCRGSRDCLDPCRRAGMRFGRCINSRCHCTP SEQ ID NO: 133 GSAVCVYRTCDRDCRRRGYRSGRCINNACRCYPYG SEQ ID NO: 134 GSISCTGSRQCYDPCRRRTGCPNARCMNRSCRCYGCG SEQ ID NO: 135 GSQVQTNVRCQGGSCASVCRREIGVAAGRCINGRCVCYRN SEQ ID NO: 136 GSEVIRCSGSRQCYGPCRQQTGCTNSRCMNRVCRCYGCG SEQ ID NO: 137 GSACRGVFDACTPGRNECCPNRVCSDRHRWCRWRL SEQ ID NO: 138 GSQIYTSRECNGSSECYSHCEGITGRRSGRCINRRCYCYR SEQ ID NO: 139 GSGCLEFWWRCNPNDDRCCRPRLRCSRLFRLCNFSFG SEQ ID NO: 140 GSDCVRFWGRCSQTSDCCPHLACRSRWPRNICVWDGSVG SEQ ID NO: 141 GSGCFGYRCDYYRGCCSGYVCSPTWRWCVRPGPGR SEQ ID NO: 142 GSMNARFILLLVLTTMMLLPDTRGAEVIRCSGSRQCYGPCRQQTGCT NSRCMNRVCRCYGCG SEQ ID NO: 143 GSMNARLIYLLLVVTTMTLMFDTAQAVDEVICSGPRQCYGPCRRETGC PNARCMNRRCRCYGCV SEQ ID NO: 144 GSMNARLIYLLLVVTTMMLTFDTTQAGDIRCSGTRQCWGPCRRQTTC TNSRCMNGRCRCYGCVG SEQ ID NO: 145 GSMNTRFIFLLLVVTNTMMLFDTRPVEGISCTGSRQCYDPCRRRTGCP NARCMNRSCRCYGCG SEQ ID NO: 146 GSGVPINVRCSGSRDCLEPCRRAGMRFGRCINRRCHCTPR SEQ ID NO: 147 GSGVPINVRCTGSPQCLRPCRDAGMRFGRCINGRCHCTPR SEQ ID NO: 148 GSGVIINVRCRISRQCLEPCRRAGMRFGRCMNGRCHCTPR SEQ ID NO: 149 GSGVPINVRCRGSPQCIQPCRDAGMRFGRCMNGRCHCTPQ SEQ ID NO: 150 GSGVEINVRCTGSHQCIRPCRDAGMRFGRCINRRCHCTPR SEQ ID NO: 151 GSGVEINVRCSGSPQCLRPCRDAGMRFGRCMNRRCHCTPR SEQ ID NO: 152 GSGVPTDVRCRGSPQCIQPCRDAGMRFGRCMNGRCHCTPR SEQ ID NO: 153 GSGVPINVSCTGSPQCIRPCRDAGMRFGRCMNRRCHCTPR SEQ ID NO: 154 GSGVPINVPCTGSPQCIRPCRDAGMRFGRCMNRRCHCTPR SEQ ID NO: 155 GSVGINVRCRHSGQCLRPCRDAGMRFGRCINGRCDCTPR SEQ ID NO: 156 GSVGINVRCRHSGQCLRPCRDAGMRFGRCMNGRCDCTPR SEQ ID NO: 157 GSVGIPVSCRHSGQCIRPCRDAGMRFGRCMNRRCDCTPR SEQ ID NO: 158 GSRRGCFREGHSCPRTAPCCRPLVCRGPSPNTRRCTRP SEQ ID NO: 159 GSSFCIPFRPCRSDENCCRRFRCRTTGIVRLCRW SEQ ID NO: 160 GSLRGCLPRNRFCNALSGPRCCSGLRCRELSIWASRCL SEQ ID NO: 161 GSGNYCLRGRCLPGGRRCCNGRPCECFARICSCRPR SEQ ID NO: 162 GSTVRCGGCNRRCCPGGCRSGRCINGRCQCY SEQ ID NO: 163 GSGCMREYCAGQCRGRVSQDYCLRHCRCIPR SEQ ID NO: 164 GSACLGFGERCNPSNDRCCRSSSLVCSQRHRWCRYG SEQ ID NO: 165 GSRGGCLPHNRFCNALSGPRCCSGLRCRELSIRDSRCLG SEQ ID NO: 166 GSRGGCLPRNRFCNPSSGPRCCSGLTCRELNIWASRCL SEQ ID NO: 167 GSQRSCARPGDMCMGIRCCDGQCGCNRGTGRCFCR SEQ ID NO: 168 GSARGCADAYRSCNHPRTCCDGYNGYRRACICSGSNCRCRRS SEQ ID NO: 169 GSRGGCLPHNRFCNALSGPRCCSGLRCRELSIWDSRCLG SEQ ID NO: 170 GSRGGCLPHNRFCNALSGPRCCSGLRCRELSIYDSRCLG SEQ ID NO: 171 GSRGGCLPHNRFCNALSGPRCCSRLRCRELSIWDSRCLG SEQ ID NO: 172 GSRGGCLPHNRFCNALTGPRCCSRLRCRELSIWDSICLG SEQ ID NO: 173 GSSCADAYKSCDSLRCCNNRTCMCSMIGTNCTCRRR SEQ ID NO: 174 GSERRCLPAGRTCVRGPMRVPCCGSCSQNRCT SEQ ID NO: 175 GSLCSREGEFCYRLRRCCAGFYCRAFVLHCYRN SEQ ID NO: 176 GSACGSCRRRCRGSGRCINGRCRCY SEQ ID NO: 177 GSACGSCRRRCRGPGRCINGRCRCY SEQ ID NO: 178 GSACQGYMRRCGRDRPPCCRRLECSRTWRWCVWN SEQ ID NO: 179 GSGRYCQRWMWTCDSRRACCEGLRCRLWCRRI SEQ ID NO: 180 GSNARCRGSPECLPRCREAIGRAAGRCMNGRCRCYP SEQ ID NO: 181 GSNVRCRGSRECLPACRAAVGRAAGRCMNGRCRCYP SEQ ID NO: 182 GSNVRCRGSPECLPRCREAIGRSAGRCMNGRCRCYP SEQ ID NO: 183 GSNARCRGSPECLPRCRQAIGRAAGRCMNGRCRCYP SEQ ID NO: 184 GSRGYCAERGIRCHNIHCCSGLTCRCRGSSCVCRR SEQ ID NO: 185 GSERGCRLTFWRCRNRRECCGWNACALGICMPR SEQ ID NO: 186 GSRRRCIARDYGRCRWGGTPCCRGRGCICSIMGTNCECRPR SEQ ID NO: 187 GSGCRLTFWRCRNRRECCGWNACALGICNIPR SEQ ID NO: 188 GSACRGLFVTCTPGRDECCPNHVCSSRHRWCRYR SEQ ID NO: 189 GSIACAPRGLLCFRDRECCRGLTCRGRFVNTWPTFCLV SEQ ID NO: 190 GSACAGLYRRCGRGVNTCCENRPCRCDLAMGNCICRRR SEQ ID NO: 191 GSFTCAISCDIRVNGRPCRGSGERRCSGGWSCRFNVCVRV SEQ ID NO: 192 GSGFCAQRGIRCHDIHCCTNLRCVREGSNRVCRRA SEQ ID NO: 193 GSCARRRNWCGRNEDCCCPMRCIYAWYNQQGSCQSTITGLFRRC SEQ ID NO: 194 GSYCQRWMWTCDSARRCCEGLVCRLWCRRI SEQ ID NO: 195 GSRGGCLPHNRFCNALSGPRCCSGLRCRELTIWNTRCLE SEQ ID NO: 196 GSNVRCTGSRQCLPACRAAVGRAAGRCMNGRCRCYT SEQ ID NO: 197 GSQRSCARPGEMCMRIRCCDGQCGCNRGTGRCFCR SEQ ID NO: 198 GSGCIPRHRRCTWSGPRCCNNISCHCNISGTLCRCRPG SEQ ID NO: 199 GSNYCVARRCRPGGRQCCSGRPCACVGRVCRCPRD SEQ ID NO: 200 GSERGCSGAYRRCSSSQRCCEGRPCVCSAINSNCRCRRT SEQ ID NO: 201 GSQRSCARPGEMCMGIRCCDGQCGCNRGTGRCFCR SEQ ID NO: 202 GSRRGCFREGRWCPRSAPCCAPLRCRGPSIRQQRCVRE SEQ ID NO: 203 GSTVRCGGCNRRCCAGGCRSGRCINGRCQCYGR SEQ ID NO: 204 GSERRCEPSGRPCRPLMRIPCCGSCVRGRCA SEQ ID NO: 205 GSRGGCLPRNRFCNPSSGPRCCSGLTCRELNIWANRCL SEQ ID NO: 206 GSCARRRNWCGRNEDCCCPMRCIYAWYNQQGSCQTTITGLFRRC SEQ ID NO: 213 GSVRIPVSCRHSGQCLRPCRDAGMRTGRCMNGRCDCTPR SEQ ID NO: 216 GSQKILSNRCNNSSECIPHCIRIFGTRAAKCINRKCYCYP SEQ ID NO: 217 GSAVCNLKRCQLSCRSLGLLGKCIGDKCECVKHG SEQ ID NO: 218 GSISIGIRCSPSIDLCEGQCRIRRYFTGYCSGDTCHCSG SEQ ID NO: 219 GSGDCLPHLRRCRENNDCCSRRCRRRGANPERRCR SEQ ID NO: 220 GSSCEPGRTFRDRCNTCKCGADGRSAACTLRACPNQ SEQ ID NO: 221 GSGDCLPHLKRCKADNDCCGKKCKRRGTNAEKRCR SEQ ID NO: 222 GSGDCLPHLKRCKENNDCCSKKCKRRGTNPEKRCR SEQ ID NO: 223 GSKDCLKKLKLCKENKDCCSKSCKRRGTNIEKRCR SEQ ID NO: 224 GSGDCLPHLKRCKENNDCCSKKCKRRGANPEKRCR SEQ ID NO: 225 GSVFINVKCRGSPECLPKCKEAIGKSAGKCMNGKCKCYP SEQ ID NO: 226 GSVFINAKCRGSPECLPKCKEAIGKAAGKCMNGKCKCYP SEQ ID NO: 227 GSVIINVKCKISRQCLEPCKKAGMRFGKCMNGKCHCTP SEQ ID NO: 228 GSVPTDVKCRGSPQCIQPCKDAGMRFGKCMNGKCHCTP SEQ ID NO: 229 GSVRIPVSCKHSGQCLKPCKDAGMRFGKCMNGKCDCTP SEQ ID NO: 230 GSVRIPVSCRHSGQCLRPCRDAGMRFGRCMNGRCDCTP SEQ ID NO: 231 GSTNVSCTTSKECWSVCQRLHNTSRGKCMNKKCRC SEQ ID NO: 232 GSNVKCTGSKQCLPACKAAVGKAAGKCMNGKCKC SEQ ID NO: 233 GSGVPINVRCRGSRDCLDPCRGAGERHGRCGNSRCHCTP SEQ ID NO: 234 GSVRIPVSCRHSGQCLRPCRDAGERHGRCGGGRCDCTPR SEQ ID NO: 235 GSQVQTNVRCQGGSCGSVCRREGGGAGGGCGNGRCGCYRN SEQ ID NO: 236 DCLPHLRRCRADNDCCGRRCRRRGTNAERRCR SEQ ID NO: 237 DCKYKFENWGACDGGTGTKVRQGTLKKARYNAQCQETIRVTKPC SEQ ID NO: 238 DCKYKFENWGACDGGTGTKVRQGTLKKARYNAQCQETIRVTKPCTP KTKAKAKAKKGKGKD SEQ ID NO: 239 SCEPGRTFRDRCNTCRCGADGRSAACTLRACPNQ SEQ ID NO: 240 QFTNVSCTTSRECWSVCQRLHNTSRGRCMNRRCRCYS SEQ ID NO: 241 MCNIPCFTTDHQMARRCDDCCGGRGRGRCYGPQCLCR SEQ ID NO: 242 ISIGIKCSPSIDLCEGQCRIRKYFTGYCSGDTCHCSG SEQ ID NO: 243 SCAKPRENCNRMNILCCRGECVCPTFGDCFCYGD SEQ ID NO: 244 NFKVEGACSKPCRKYCIDKGARNGKCINGRCHCYY SEQ ID NO: 245 DRDSCIDKSRCSKYGYYQECQDCCKKAGHNGGTCMFFKCKCA SEQ ID NO: 246 QFCGTNGKPCVNGQCCGALRCVVTYHYADGVCLKMNP SEQ ID NO: 247 RPTDIKCSASYQCFPVCKSRFGKTNGRCVNGLCDCF SEQ ID NO: 248 NCAGYMRECKEKLCCSGYVCSSRWKWCVLPAPWRR SEQ ID NO: 249 QFTDVKCTGSKQCWPVCKQMFGKPNGKCMNGKCRCYS SEQ ID NO: 250 QIDTNVKCSGSSKCVKICIDRYNTRGAKCINGRCTCYP SEQ ID NO: 251 AEIIRCSGTRECYAPCQKLTGCLNAKCMNKACKCYGCV SEQ ID NO: 252 SDYCSNDFCFFSCRRDRCARGDCENGKCVCKNCHLN SEQ ID NO: 253 CIGEGVPCDENDPRCCFGLVCLKPTLHGIWYKSYYCYKK SEQ ID NO: 254 SCAKPGEMCMRIKCCDGQCGCNRGTGRCFCK SEQ ID NO: 255 ACLAEYQKCEGSTVPCCPGLSCSAGRFRKTKLCTK SEQ ID NO: 256 VVIGQRCYRSPDCYSACKKLVGKATGKCTNGRCDC SEQ ID NO: 257 ACQFWSCNSSCISRGYRQGYCWGIQYKYCQCQ SEQ ID NO: 258 RCPPCFTTNPNMEADCRKCCGGRGYCASYQCICPGG SEQ ID NO: 259 QVSTNKKCSNTSQCYKTCEKVVGVAAGKCMNGKCICYP SEQ ID NO: 260 ECLEIFKACNPSNDQCCKSSKLVCSRKTRWCKYQIG SEQ ID NO: 261 QDKCKKVYENYPVSKCQLANQCNYDCKLDKHARSGECFYDEKRNL QCICDYCEY SEQ ID NO: 262 GHACYRNCWREGNDEETCKERC SEQ ID NO: 263 MCMPCFTTDTQMQERCDRCCGGGGRGRCWGPQCLCI SEQ ID NO: 264 MCMPCFTTEQRMAIICDDCCGGFGRGRCYGPQCLCR SEQ ID NO: 265 ICIPCFTTDHQIARRCDDCCGGRGRGRCYGPQCICR SEQ ID NO: 266 RCQLQGFNCVVRSYGLPTIPCCRGLTCRSYFPGSTYGRCQRY SEQ ID NO: 267 SFGLCRLRRGFCARGRCRFPSIPIGRCSRFVQCCRRVW SEQ ID NO: 268 SCEPGTTFRDRCNTCRCGSDGRSAACTLRACPQ SEQ ID NO: 269 SCTPGTTFRDRCNTCRCSSNGRSAACTLRACPPGSY SEQ ID NO: 270 SCTPGTTFRNRCNTCRCGSNGRSASCTLMACPPGSY SEQ ID NO: 271 SCTPGATFRNRCNTCRCGSNGRSASCTLMACPPGSY SEQ ID NO: 272 SCQPGTTYQRGCNTCRCLEDGQTEACTLRLC SEQ ID NO: 273 SCTPGATYREGCNICRCRSDGRSGACTRRICPVDSN SEQ ID NO: 274 SCQPGTTFRRDCNTCVCNRDGTNAACTLRACL SEQ ID NO: 275 YSRCQLQGFNCVVRSYGLPTIPCCRGLTCRSYFPGSTYGRCQRY SEQ ID NO: 276 SCARPRENCNRMNILCCRGECVCPTFGDCFCYGD SEQ ID NO: 277 GIVCKVCKIICGMQGKKVNICKAPIKCKCKKG SEQ ID NO: 278 SEKDCIKHLQRCRENKDCCSKKCSRRGTNPEKRCR SEQ ID NO: 279 VRIPVSCKHSGQCLKPCKDAGMRFGKCMNGKCDCTPK SEQ ID NO: 280 GVPINVKCRGSRDCLDPCKKAGMRFGKCINSKCHCTP SEQ ID NO: 281 AVCVYRTCDKDCKRRGYRSGKCINNACKCYPYG SEQ ID NO: 282 ISCTGSKQCYDPCKRKTGCPNAKCMNKSCKCYGCG SEQ ID NO: 283 QVQTNVKCQGGSCASVCRREIGVAAGKCINGKCVCYRN SEQ ID NO: 284 EVIRCSGSKQCYGPCKQQTGCTNSKCMNKVCKCYGCG SEQ ID NO: 285 ACKGVFDACTPGKNECCPNRVCSDKHKWCKWKL SEQ ID NO: 286 QIYTSKECNGSSECYSHCEGITGKRSGKCINKKCYCYR SEQ ID NO: 287 GCLEFWWKCNPNDDKCCRPKLKCSKLFKLCNFSFG SEQ ID NO: 288 DCVRFWGKCSQTSDCCPHLACKSKWPRNICVWDGSVG SEQ ID NO: 289 GCFGYKCDYYKGCCSGYVCSPTWKWCVRPGPGR SEQ ID NO: 290 MNAKFILLLVLTTMMLLPDTKGAEVIRCSGSKQCYGPCKQQTGCTNS KCMNKVCKCYGCG SEQ ID NO: 291 MNAKLIYLLLVVTTMTLMFDTAQAVDIMCSGPKQCYGPCKKETGCP NAKCMNRRCKCYGCV SEQ ID NO: 292 MNAKLIYLLLVVTTMMLTFDTTQAGDIKCSGTRQCWGPCKKQTTCT NSKCMNGKCKCYGCVG SEQ ID NO: 293 MNTKFIFLLLVVTNTMMLFDTKPVEGISCTGSKQCYDPCKRKTGCPN AKCMNKSCKCYGCG SEQ ID NO: 294 GVPINVKCSGSRDCLEPCKKAGMRFGKCINRKCHCTPK SEQ ID NO: 295 GVPINVKCTGSPQCLKPCKDAGMRFGKCINGKCHCTPK SEQ ID NO: 296 GVIINVKCKISRQCLEPCKKAGMRFGKCMNGKCHCTPK SEQ ID NO: 297 GVPINVKCRGSPQCIQPCRDAGMRFGKCMNGKCHCTPQ SEQ ID NO: 298 GVEINVKCTGSHQCIKPCKDAGMRFGKCINRKCHCTPK SEQ ID NO: 299 GVEINVKCSGSPQCLKPCKDAGMRFGKCMNRKCHCTPK SEQ ID NO: 300 GVPTDVKCRGSPQCIQPCKDAGMRFGKCMNGKCHCTPK SEQ ID NO: 301 GVPINVSCTGSPQCIKPCKDAGMRFGKCMNRKCHCTPK SEQ ID NO: 302 GVPINVPCTGSPQCIKPCKDAGMRFGKCMNRKCHCTPK SEQ ID NO: 303 VGINVKCKHSGQCLKPCKDAGMRFGKCINGKCDCTPK SEQ ID NO: 304 VGINVKCKHSGQCLKPCKDAGMRFGKCMNGKCDCTPK SEQ ID NO: 305 VGIPVSCKHSGQCIKPCKDAGMRFGKCMNRKCDCTPK SEQ ID NO: 306 RKGCFKEGHSCPKTAPCCRPLVCKGPSPNTKKCTRP SEQ ID NO: 307 SFCIPFKPCKSDENCCKKFKCKTTGIVKLCRW SEQ ID NO: 308 LKGCLPRNRFCNALSGPRCCSGLRCKELSIWASKCL SEQ ID NO: 309 GNYCLRGRCLPGGRKCCNGRPCECFAKICSCKPK SEQ ID NO: 310 TVKCGGCNRKCCPGGCRSGKCINGKCQCY SEQ ID NO: 311 GCMKEYCAGQCRGKVSQDYCLKHCKCIPR SEQ ID NO: 312 ACLGFGEKCNPSNDKCCKSSSLVCSQKHKWCKYG SEQ ID NO: 313 RGGCLPHNRFCNALSGPRCCSGLRCKELSIRDSRCLG SEQ ID NO: 314 RGGCLPRNKFCNPSSGPRCCSGLTCKELNIWASKCL SEQ ID NO: 315 QRSCAKPGDMCMGIKCCDGQCGCNRGTGRCFCK SEQ ID NO: 316 ARGCADAYKSCNHPRTCCDGYNGYKRACICSGSNCKCKKS SEQ ID NO: 317 RGGCLPHNRFCNALSGPRCCSGLRCKELSIWDSRCLG SEQ ID NO: 318 RGGCLPHNRFCNALSGPRCCSGLKCKELSIYDSRCLG SEQ ID NO: 319 RGGCLPHNRFCNALSGPRCCSRLKCKELSIWDSRCLG SEQ ID NO: 320 RGGCLPHNRFCNALTGPRCCSRLRCKELSIWDSICLG SEQ ID NO: 321 SCADAYKSCDSLKCCNNRTCMCSMIGTNCTCRKK SEQ ID NO: 322 ERRCLPAGKTCVRGPMRVPCCGSCSQNKCT SEQ ID NO: 323 LCSREGEFCYKLRKCCAGFYCKAFVLHCYRN SEQ ID NO: 324 ACGSCRKKCKGSGKCINGRCKCY SEQ ID NO: 325 ACGSCRKKCKGPGKCINGRCKCY SEQ ID NO: 326 ACQGYMRKCGRDKPPCCKKLECSKTWRWCVWN SEQ ID NO: 327 GRYCQKWMWTCDSKRACCEGLRCKLWCRKI SEQ ID NO: 328 NAKCRGSPECLPKCKEAIGKAAGKCMNGKCKCYP SEQ ID NO: 329 NVKCRGSKECLPACKAAVGKAAGKCMNGKCKCYP SEQ ID NO: 330 NVKCRGSPECLPKCKEAIGKSAGKCMNGKCKCYP SEQ ID NO: 331 NAKCRGSPECLPKCKQAIGKAAGKCMNGKCKCYP SEQ ID NO: 332 RGYCAEKGIKCHNIHCCSGLTCKCKGSSCVCRK SEQ ID NO: 333 ERGCKLTFWKCKNKKECCGWNACALGICMPR SEQ ID NO: 334 KKKCIAKDYGRCKWGGTPCCRGRGCICSIMGTNCECKPR SEQ ID NO: 335 GCKLTFWKCKNKKECCGWNACALGICMPR SEQ ID NO: 336 ACKGLFVTCTPGKDECCPNHVCSSKHKWCKYK SEQ ID NO: 337 IACAPRGLLCFRDKECCKGLTCKGRFVNTWPTFCLV SEQ ID NO: 338 ACAGLYKKCGKGVNTCCENRPCKCDLAMGNCICKKK SEQ ID NO: 339 FTCAISCDIKVNGKPCKGSGEKKCSGGWSCKFNVCVKV SEQ ID NO: 340 GFCAQKGIKCHDIHCCTNLKCVREGSNRVCRKA SEQ ID NO: 341 CAKKRNWCGKNEDCCCPMKCIYAWYNQQGSCQSTITGLFKKC SEQ ID NO: 342 YCQKWMWTCDSARKCCEGLVCRLWCKKI SEQ ID NO: 343 RGGCLPHNKFCNALSGPRCCSGLKCKELTIWNTKCLE SEQ ID NO: 344 NVKCTGSKQCLPACKAAVGKAAGKCMNGKCKCYT SEQ ID NO: 345 QRSCAKPGEMCMRIKCCDGQCGCNRGTGRCFCK SEQ ID NO: 346 GCIPKHKRCTWSGPKCCNNISCHCNISGTLCKCRPG SEQ ID NO: 347 NYCVAKRCRPGGRQCCSGKPCACVGKVCKCPRD SEQ ID NO: 348 ERGCSGAYKRCSSSQRCCEGRPCVCSAINSNCKCRKT SEQ ID NO: 349 RYCPRNPEACYNYCLRTGRPGGYCGGRSRITCFCFR SEQ ID NO: 350 QRSCAKPGEMCMGIKCCDGQCGCNRGTGRCFCK SEQ ID NO: 351 RRGCFKEGKWCPKSAPCCAPLKCKGPSIKQQKCVRE SEQ ID NO: 352 TVKCGGCNRKCCAGGCRSGKCINGKCQCYGR SEQ ID NO: 353 ERRCEPSGKPCRPLMRIPCCGSCVRGKCA SEQ ID NO: 354 RGGCLPRNKFCNPSSGPRCCSGLTCKELNIWANKCL SEQ ID NO: 355 CAKKRNWCGKNEDCCCPMKCIYAWYNQQGSCQTTITGLFKKC SEQ ID NO: 362 VRIPVSCKHSGQCLKPCKDAGMRTGKCMNGKCDCTPK SEQ ID NO: 363 VKCTTSKDCWPPCKKVTGRA SEQ ID NO: 364 GIVCRVCRIICGMQGRRVNICRAPIRCRCRRG SEQ ID NO: 365 SERDCIRHLQRCRENRDCCSRRCSRRGTNPERRCR SEQ ID NO: 366 VRIPVSCRHSGQCLRPCRDAGMRFGRCMNGRCDCTPR SEQ ID NO: 367 GVPINVRCRGSRDCLDPCRRAGMRFGRCINSRCHCTP SEQ ID NO: 368 AVCVYRTCDRDCRRRGYRSGRCINNACRCYPYG SEQ ID NO: 369 ISCTGSRQCYDPCRRRTGCPNARCMNRSCRCYGCG SEQ ID NO: 370 QVQTNVRCQGGSCASVCRREIGVAAGRCINGRCVCYRN SEQ ID NO: 371 EVIRCSGSRQCYGPCRQQTGCTNSRCMNRVCRCYGCG SEQ ID NO: 372 ACRGVFDACTPGRNECCPNRVCSDRHRWCRWRL SEQ ID NO: 373 QIYTSRECNGSSECYSHCEGITGRRSGRCINRRCYCYR SEQ ID NO: 374 GCLEFWWRCNPNDDRCCRPRLRCSRLFRLCNFSFG SEQ ID NO: 375 DCVRFWGRCSQTSDCCPHLACRSRWPRNICVWDGSVG SEQ ID NO: 376 GCFGYRCDYYRGCCSGYVCSPTWRWCVRPGPGR SEQ ID NO: 377 MNARFILLLVLTTMMLLPDTRGAEVIRCSGSRQCYGPCRQQTGCTNS RCMNRVCRCYGCG SEQ ID NO: 378 MNARLIYLLLVVTTMTLMFDTAQAVDIMCSGPRQCYGPCRRETGCPN ARCMNRRCRCYGCV SEQ ID NO: 379 MNARLIYLLLVVTTMMLTFDTTQAGDIRCSGTRQCWGPCRRQTTCTN SRCMNGRCRCYGCVG SEQ ID NO: 380 MNTRFIFLLLVVTNTMMLFDTRPVEGISCTGSRQCYDPCRRRTGCPNA RCMNRSCRCYGCG SEQ ID NO: 381 GVPINVRCSGSRDCLEPCRRAGMRFGRCINRRCHCTPR SEQ ID NO: 382 GVPINVRCTGSPQCLRPCRDAGMRFGRCINGRCHCTPR SEQ ID NO: 383 GVIINVRCRISRQCLEPCRRAGMRFGRCMNGRCHCTPR SEQ ID NO: 384 GVPINVRCRGSPQCIQPCRDAGMRFGRCMNGRCHCTPQ SEQ ID NO: 385 GVEINVRCTGSHQCIRPCRDAGMRFGRCINRRCHCTPR SEQ ID NO: 386 GVEINVRCSGSPQCLRPCRDAGMRFGRCMNRRCHCTPR SEQ ID NO: 387 GVPTDVRCRGSPQCIQPCRDAGMRFGRCMNGRCHCTPR SEQ ID NO: 388 GVPINVSCTGSPQCIRPCRDAGMRFGRCMNRRCHCTPR SEQ ID NO: 389 GVPINVPCTGSPQCIRPCRDAGMRFGRCMNRRCHCTPR SEQ ID NO: 390 VGINVRCRHSGQCLRPCRDAGMRFGRCINGRCDCTPR SEQ ID NO: 391 VGINVRCRHSGQCLRPCRDAGMRFGRCMNGRCDCTPR SEQ ID NO: 392 VGIPVSCRHSGQCIRPCRDAGMRFGRCMNRRCDCTPR SEQ ID NO: 393 RRGCFREGHSCPRTAPCCRPLVCRGPSPNTRRCTRP SEQ ID NO: 394 SFCIPFRPCRSDENCCRRFRCRTTGIVRLCRW SEQ ID NO: 395 LRGCLPRNRFCNALSGPRCCSGLRCRELSIWASRCL SEQ ID NO: 396 GNYCLRGRCLPGGRRCCNGRPCECFARICSCRPR SEQ ID NO: 397 TVRCGGCNRRCCPGGCRSGRCINGRCQCY SEQ ID NO: 398 GCMREYCAGQCRGRVSQDYCLRHCRCIPR SEQ ID NO: 399 ACLGFGERCNPSNDRCCRSSSLVCSQRHRWCRYG SEQ ID NO: 400 RGGCLPHNRFCNALSGPRCCSGLRCRELSIRDSRCLG SEQ ID NO: 401 RGGCLPRNRFCNPSSGPRCCSGLTCRELNIWASRCL SEQ ID NO: 402 QRSCARPGDMCMGIRCCDGQCGCNRGTGRCFCR SEQ ID NO: 403 ARGCADAYRSCNHPRTCCDGYNGYRRACICSGSNCRCRRS SEQ ID NO: 404 RGGCLPHNRFCNALSGPRCCSGLRCRELSIWDSRCLG SEQ ID NO: 405 RGGCLPHNRFCNALSGPRCCSGLRCRELSIYDSRCLG SEQ ID NO: 406 RGGCLPHNRFCNALSGPRCCSRLRCRELSIWDSRCLG SEQ ID NO: 407 RGGCLPHNRFCNALTGPRCCSRLRCRELSIWDSICLG SEQ ID NO: 408 SCADAYKSCDSLRCCNNRTCMCSMIGTNCTCRRR SEQ ID NO: 409 ERRCLPAGRTCVRGPMRVPCCGSCSQNRCT SEQ ID NO: 410 LCSREGEFCYRLRRCCAGFYCRAFVLHCYRN SEQ ID NO: 411 ACGSCRRRCRGSGRCINGRCRCY SEQ ID NO: 412 ACGSCRRRCRGPGRCINGRCRCY SEQ ID NO: 413 ACQGYMRRCGRDRPPCCRRLECSRTWRWCVWN SEQ ID NO: 414 GRYCQRWMWTCDSRRACCEGLRCRLWCRRI SEQ ID NO: 415 NARCRGSPECLPRCREAIGRAAGRCMNGRCRCYP SEQ ID NO: 416 NVRCRGSRECLPACRAAVGRAAGRCMNGRCRCYP SEQ ID NO: 417 NVRCRGSPECLPRCREAIGRSAGRCMNGRCRCYP SEQ ID NO: 418 NARCRGSPECLPRCRQAIGRAAGRCMNGRCRCYP SEQ ID NO: 419 RGYCAERGIRCHNIHCCSGLTCRCRGSSCVCRR SEQ ID NO: 420 ERGCRLTFWRCRNRRECCGWNACALGICMPR SEQ ID NO: 421 RRRCIARDYGRCRWGGTPCCRGRGCICSIMGTNCECRPR SEQ ID NO: 422 GCRLTFWRCRNRRECCGWNACALGICMPR SEQ ID NO: 423 ACRGLFVTCTPGRDECCPNHVCSSRHRWCRYR SEQ ID NO: 424 IACAPRGLLCFRDRECCRGLTCRGRFVNTWPTFCLV SEQ ID NO: 425 ACAGLYRRCGRGVNTCCENRPCRCDLAMGNCICRRR SEQ ID NO: 426 FTCAISCDIRVNGRPCRGSGERRCSGGWSCRFNVCVRV SEQ ID NO: 427 GFCAQRGIRCHDIHCCTNLRCVREGSNRVCRRA SEQ ID NO: 428 CARRRNWCGRNEDCCCPMIRCIYAWYNQQGSCQSTITGLFRRC SEQ ID NO: 429 YCQRWMWTCDSARRCCEGLVCRLWCRRI SEQ ID NO: 430 RGGCLPHNRFCNALSGPRCCSGLRCRELTIWNTRCLE SEQ ID NO: 431 NVRCTGSRQCLPACRAAVGRAAGRCMNGRCRCYT SEQ ID NO: 432 QRSCARPGEMCMRIRCCDGQCGCNRGTGRCFCR SEQ ID NO: 433 GCIPRHRRCTWSGPRCCNNISCHCNISGTLCRCRPG SEQ ID NO: 434 NYCVARRCRPGGRQCCSGRPCACVGRVCRCPRD SEQ ID NO: 435 ERGCSGAYRRCSSSQRCCEGRPCVCSAINSNCRCRRT SEQ ID NO: 436 QRSCARPGEMCMGIRCCDGQCGCNRGTGRCFCR SEQ ID NO: 437 RRGCFREGRWCPRSAPCCAPLRCRGPSIRQQRCVRE SEQ ID NO: 438 TVRCGGCNRRCCAGGCRSGRCINGRCQCYGR SEQ ID NO: 439 ERRCEPSGRPCRPLMRIPCCGSCVRGRCA SEQ ID NO: 440 RGGCLPRNRFCNPSSGPRCCSGLTCRELNIWANRCL SEQ ID NO: 441 CARRRNWCGRNEDCCCPMRCIYAWYNQQGSCQTTITGLFRRC SEQ ID NO: 448 VRIPVSCRHSGQCLRPCRDAGMRTGRCMNGRCDCTPR SEQ ID NO: 451 QKILSNRCNNSSECIPHCIRIFGTRAAKCINRKCYCYP SEQ ID NO: 452 AVCNLKRCQLSCRSLGLLGKCIGDKCECVKHG SEQ ID NO: 453 ISIGIRCSPSIDLCEGQCRIRRYFTGYCSGDTCHCSG SEQ ID NO: 454 GDCLPHLRRCRENNDCCSRRCRRRGANPERRCR SEQ ID NO: 455 SCEPGRTFRDRCNTCKCGADGRSAACTLRACPNQ SEQ ID NO: 456 GDCLPHLKRCKADNDCCGKKCKRRGTNAEKRCR SEQ ID NO: 457 GDCLPHLKRCKENNDCCSKKCKRRGTNPEKRCR SEQ ID NO: 458 KDCLKKLKLCKENKDCCSKSCKRRGTNIEKRCR SEQ ID NO: 459 GDCLPHLKRCKENNDCCSKKCKRRGANPEKRCR SEQ ID NO: 460 VFINVKCRGSPECLPKCKEAIGKSAGKCMNGKCKCYP SEQ ID NO: 461 VFINAKCRGSPECLPKCKEAIGKAAGKCMNGKCKCYP SEQ ID NO: 462 VIINVKCKISRQCLEPCKKAGMRFGKCMNGKCHCTP SEQ ID NO: 463 VPTDVKCRGSPQCIQPCKDAGMRFGKCMNGKCHCTP SEQ ID NO: 464 VRIPVSCKHSGQCLKPCKDAGMRFGKCMNGKCDCTP SEQ ID NO: 465 VRIPVSCRHSGQCLRPCRDAGMRFGRCMNGRCDCTP SEQ ID NO: 466 TNVSCTTSKECWSVCQRLHNTSRGKCMNKKCRC SEQ ID NO: 467 NVKCTGSKQCLPACKAAVGKAAGKCMNGKCKC SEQ ID NO: 468 GVPINVRCRGSRDCLDPCRGAGERHGRCGNSRCHCTP SEQ ID NO: 469 VRIPVSCRHSGQCLRPCRDAGERHGRCGGGRCDCTPR SEQ ID NO: 470 QVQTNVRCQGGSCGSVCRREGGGAGGGCGNGRCGCYRN SEQ ID NO: 471 GGDCLPHLRRCRADNDCCGRRCRRRGTNAERRCR SEQ ID NO: 472 GGDCKYKFENWGACDGGTGTKVRQGTLKKARYNAQCQETIRVTKP C SEQ ID NO: 473 GGDCKYKFENWGACDGGTGTKVRQGTLKKARYNAQCQETIRVTKP CTPKTKAKAKAKKGKGKD SEQ ID NO: 474 GGSCEPGRTFRDRCNTCRCGADGRSAACTLRACPNQ SEQ ID NO: 475 GGQFTNVSCTTSRECWSVCQRLHNTSRGRCMNRRCRCYS SEQ ID NO: 476 GGMCMPCFTTDHQMARRCDDCCGGRGRGRCYGPQCLCR SEQ ID NO: 477 GGISIGIKCSPSIDLCEGQCRIRKYFTGYCSGDTCHCSG SEQ ID NO: 478 GGEVIRCSGSKQCYGPCKQQTGCTNSKCMNKVCKCYGCG SEQ ID NO: 479 GGSEKDCIKHLQRCRENKDCCSKKCSRRGTNPEKRCR SEQ ID NO: 480 GGSCAKPRENCNRMNILCCRGECVCPTFGDCFCYGD SEQ ID NO: 481 GGGVPINVKCRGSRDCLDPCKKAGMRFGKCINSKCHCTP SEQ ID NO: 482 GGVRIPVSCKHSGQCLKPCKDAGMRFGKCMNGKCDCTPK SEQ ID NO: 483 GGGIVCKVCKIICGMQGKKVNICKApIKCKCKKG SEQ ID NO: 484 GGDCVRFWGKCSQTSDCCPHLACKSKWPRNICVWDGSVG SEQ ID NO: 485 GGAVCVYRTCDKDCKRRGYRSGKCINNACKCYPYG SEQ ID NO: 486 GGGCFGYKCDYYKGCCSGYVCSPTWKWCVRPGPGR SEQ ID NO: 487 GGQVQTNVKCQGGSCASVCRREIGVAAGKCINGKCVCYRN SEQ ID NO: 488 GGGDCLPHLKRCKENNDCCSKKCKRRGANPEKRCR SEQ ID NO: 489 GGNFKVEGACSKPCRKYCIDKGARNGKCINGRCHCYY SEQ ID NO: 490 GGQKILSNRCNNSSECIPHCIRIFGTRAAKCINRKCYCYP SEQ ID NO: 491 GGDRDSCIDKSRCSKYGYYQECQDCCKKAGHNGGTCMFFKCKCA SEQ ID NO: 492 GGAVCNLKRCQLSCRSLGLLGKCIGDKCECVKHG SEQ ID NO: 493 GGQFCGTNGKPCVNGQCCGALRCVVTYHYADGVCLKMNP SEQ ID NO: 494 GGRPTDIKCSASYQCFPVCKSRFGKTNGRCVNGLCDCF SEQ ID NO: 495 GGNCAGYMRECKEKLCCSGYVCSSRWKWCVLPAPWRR SEQ ID NO: 496 GGQFTDVKCTGSKQCWPVCKQMFGKPNGKCMNGKCRCYS SEQ ID NO: 497 GGQIDTNVKCSGSSKCVKICIDRYNTRGAKCINGRCTCYP SEQ ID NO: 498 GGAEIIRCSGTRECYAPCQKLTGCLNAKCMNKACKCYGCV SEQ ID NO: 499 GGSDYCSNDFCFFSCRRDRCARGDCENGKCVCKNCHLN SEQ ID NO: 500 GGCIGEGVPCDENDPRCCFGLVCLKPTLHGIWYKSYYCYKK SEQ ID NO: 501 GGSCAKPGEMCMRIKCCDGQCGCNRGTGRCFCK SEQ ID NO: 502 GGACLAEYQKCEGSTVPCCPGLSCSAGRFRKTKLCTK SEQ ID NO: 503 GGVVIGQRCYRSPDCYSACKKLVGKATGKCTNGRCDC SEQ ID NO: 504 GGACQFWSCNSSCISRGYRQGYCWGIQYKYCQCQ SEQ ID NO: 505 GGRCPPCFTTNPNMEADCRKCCGGRGYCASYQCICPGG SEQ ID NO: 506 GGVFINVKCRGSPECLPKCKEAIGKSAGKCMNGKCKCYP SEQ ID NO: 507 GGQVSTNKKCSNTSQCYKTCEKVVGVAAGKCMNGKCICYP SEQ ID NO: 508 GGECLEIFKACNPSNDQCCKSSKLVCSRKTRWCKYQIG SEQ ID NO: 509 GGQDKCKKVYENYPVSKCQLANQCNYDCKLDKHARSGECFYDEKR NLQCICDYCEY SEQ ID NO: 510 GGGHACYRNCWREGNDEETCKERC SEQ ID NO: 511 GGMCNIPCFTTDTQMQERCDRCCGGGGRGRCWGPQCLCI SEQ ID NO: 512 GGMCNIPCFTTEQRMAIICDDCCGGFGRGRCYGPQCLCR SEQ ID NO: 513 GGICIPCFTTDHQIARRCDDCCGGRGRGRCYGPQCICR SEQ ID NO: 514 GGRCQLQGFNCVVRSYGLPTIPCCRGLTCRSYFPGSTYGRCQRY SEQ ID NO: 515 GGSFGLCRLRRGFCARGRCRFPSIPIGRCSRFVQCCRRVW SEQ ID NO: 516 GGSCEPGTTFRDRCNTCRCGSDGRSAACTLRACPQ SEQ ID NO: 517 GGSCTPGTTFRDRCNTCRCSSNGRSAACTLRACPPGSY SEQ ID NO: 518 GGSCTPGTTFRNRCNTCRCGSNGRSASCTLMACPPGSY SEQ ID NO: 519 GGSCTPGATFRNRCNTCRCGSNGRSASCTLMACPPGSY SEQ ID NO: 520 GGSCQPGTTYQRGCNTCRCLEDGQTEACTLRLC SEQ ID NO: 521 GGSCTPGATYREGCNICRCRSDGRSGACTRRICPVDSN SEQ ID NO: 522 GGSCQPGTTFRRDCNTCVCNRDGTNAACTLRACL SEQ ID NO: 523 GSYSRCQLQGFNCVVRSYGLPTIPCCRGLTCRSYFPGSTYGRCQRY SEQ ID NO: 524 GGSCARPRENCNRMNILCCRGECVCPTFGDCFCYGD SEQ ID NO: 525 GGGVPINVRCRGSRDCLDPCRRAGMRFGRCINSRCHCTP SEQ ID NO: 526 GGSERDCIRHLQRCRENRDCCSRRCSRRGTNPERRCR SEQ ID NO: 527 GGVRIPVSCRHSGQCLRPCRDAGMRFGRCMNGRCDCTPR SEQ ID NO: 528 GGQVQTNVRCQGGSCASVCRREIGVAAGRCINGRCVCYRN SEQ ID NO: 529 GGGDCLPHLRRCRENNDCCSRRCRRRGANPERRCR

In any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 529, or any fragment thereof, any one or more K residues can be replaced by an R residue, any one or more R residues can be replaced by a K residue or an A residue, any one or more A residues can be replaced by a K residue or an R residue, all K residues can be replaced by R residues or A residues, all but one K residue can be replaced by R or A residues, all but two K residues can be replaced by R residues or A residues, or in any combination thereof. In any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 569, or any fragment thereof, any one or more M residues can be replaced by any one of I, L, or V residues, any one or more L residues can be replaced by any one of V, I, or M residues, any one or more I residues can be replaced by any one of M, L, or V residues, or any one or more V residues can be replaced by any one of I, L, or M residues. In any embodiment, at least one of the amino acids alone or in combination can be interchanged in the peptides or peptide fragments as follows: K/R, M/I L/V, G/A, S/T, Q/N, and D/E wherein each letter is each individually any amino acid or amino acid analogue. In some instances, the peptide can contain only one lysine residue, or no lysine residue. In any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 569, or any fragment thereof, any amino acid can be replaced with citrulline. In any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 569, or any fragment thereof, X can independently be any number of any amino acid or no amino acid. In some cases, a peptide can include the first two N-terminal amino acids GS, as with peptides of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 235, SEQ ID NO: 530-SEQ ID NO: 549, and SEQ ID NO: 570, a peptide can include the first two N-terminal amino acids GG, as with peptides of SEQ ID NO: 471-SEQ ID NO: 529, or such N-terminal amino acids (GS or GG) can be substituted by any other one or two amino acids. In other cases, a peptide does not include the first two N-terminal amino acids GS, as with peptides of SEQ ID NO: 236-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 470, and SEQ ID NO: 550-SEQ ID NO: 569. In some cases, the N-terminus of the peptide is blocked, such as by an acetyl group; in other instances the C-terminus of the peptide is block, such as by an amide group.

In some instances, the peptide is any one of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 569, or a functional fragment thereof. In other embodiments, the peptide of the disclosure further comprises a peptide with 100%, 99%, 97%, 95%, 90%, 85%, or 80% homology to any one of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 569. In further embodiments, the peptide fragment comprises a contiguous fragment of any one of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 569 that is at least 17, at least 18, at least 19, at least 20, at least 21, at least 22, at least 23, at least 24, at least 25, at least 26, at least 27, at least 28, at least 29, at least 30, at least 31, at least 32, at least 33, at least 34, at least 35, at least 36, at least 37, at least 38, at least 39, at least 40, at least 41, at least 42, at least 43, at least 44, at least 45, at least 46 residues long, wherein the peptide fragment is selected from any portion of the peptide. In some embodiments, such peptide fragments contact the kidney and exhibit properties of those described herein for peptide and peptide-active agent conjugates.

The peptides of the present disclosure can further comprise negative amino acid residues. In some cases, the peptide has 2 or fewer negative amino acid residues. In other cases, the peptide has 4 or fewer negative amino acid residues, 3 or fewer negative amino acid residues, or 1 or fewer negative amino acid residues. The negative amino acid residues can be selected from any negative charged amino acid residues. The negative amino acid residues can selected from either E or D, or a combination of both E and D.

The peptides of the present disclosure can further comprise basic amino acid residues. In some embodiments, basic residues are added to the peptide sequence to increase the charge at physiological pH. The added basic residues can be any basic amino acid. The added basic residues can be selected from K or R, or a combination of K or R.

In some embodiments, the peptide has a charge distribution comprising an acidic region and a basic region. An acidic region can be a nub. A nub is a portion of a peptide extending out of the peptide's three-dimensional structure. A basic region can be a patch. A patch is a portion of a peptide that does not designate any specific topology characteristic of the peptide's three-dimensional structure. In further embodiments, a cystine-dense peptide can be 6 or more basic residues and 2 or fewer acidic residues.

The peptides of the present disclosure can further comprise positively charged amino acid residues. In some cases, the peptide has at least 2 positively charged residues. In other cases, the peptide has at least 3 positively charged residues, at least 4 positively charged residues, at least 5 positively charged residues, at least 6 positively charged residues, at least 7 positively charged residues, at least 8 positively charged residues or at least 9 positively charged residues. The positively charged residues can be selected from any positively charged amino acid residues. The positively charged residues can be selected from either K or R, or a combination of K and R.

In addition, the peptides herein can comprise a 4-19 amino acid residue fragment of any of the above sequences containing at least 2 cysteine residues, and at least 2 or 3 positively charged amino acid residues (for example, arginine, lysine or histidine, or any combination of arginine, lysine or histidine). In other embodiments, the peptides herein is a 20-70 amino acid residue fragment of any of the above sequences containing at least 2 cysteine residues, no more than 2 basic residues, and at least 2 or 3 positively charged amino acid residues (for example, arginine, lysine or histidine, or any combination of arginine, lysine or histidine). In some embodiments, such peptide fragments contact the kidney and exhibit properties of those described herein for peptide and peptide-active agent conjugates.

In some embodiments, the peptide contains one or more disulfide bonds and has a positive net charge at neutral pH. At physiological pH, peptides can have a net charge, for example, of −5, −4, −3, −2, −1, 0, +1, +2, +3, +4, or +5. When the net charge is zero, the peptide can be uncharged or zwitterionic. In some instances, the peptide can have a positive charge at physiological pH. In some instances, the peptide can have a charge ≥+2 at physiological pH, ≥+3.5 at physiological pH, ≥+4.5 at physiological pH. In some embodiments, the peptide contains one or more disulfide bonds and has a positive net charge at neutral pH where the net charge can be +0.5 or less than +0.5, +1 or less than +1, +1.5 or less than +1.5, +2 or less than +2, +2.5 or less than +2.5, +3 or less than +3, +3.5 or less than +3.5, +4 or less than +4, +4.5 or less than +4.5, +5 or less than +5, +5.5 or less than +5.5, +6 or less than +6, +6.5 or less than +6.5, +7 or less than +7, +7.5 or less than +7.5, +8 or less than +8, +8.5 or less than +8.5, +9 or less than +9.5, +10 or less than +10. In some embodiments, the peptide has a negative net charge at physiological pH where the net charge can be −0.5 or less than −0.5, −1 or less than −1, −1.5 or less than −1.5, −2 or less than −2, −2.5 or less than −2.5, −3 or less than −3, −3.5 or less than −3.5, −4 or less than −4, −4.5 or less than −4.5, −5 or less than −5, −5.5 or less than −5.5, −6 or less than −6, −6.5 or less than −6.5, −7 or less than −7, −7.5 or less than −7.5, −8 or less than −8, −8.5 or less than −8.5, −9 or less than −9.5, −10 or less than −10. In some cases, the engineering of one or more mutations within a peptide yields a peptide with an altered isoelectric point, charge, surface charge, or rheology at physiological pH. Such engineering of a mutation to a peptide derived from a scorpion or spider can change the net charge of the complex, for example, by decreasing the net charge by 1, 2, 3, 4, or 5, or by increasing the net charge by 1, 2, 3, 4, or 5. In such cases, the engineered mutation may facilitate the ability of the peptide to contact the kidney. Suitable amino acid modifications for improving the rheology and potency of a peptide can include conservative or non-conservative mutations. A peptide can comprises at most 1 amino acid mutation, at most 2 amino acid mutations, at most 3 amino acid mutations, at most 4 amino acid mutations, at most 5 amino acid mutations, at most 6 amino acid mutations, at most 7 amino acid mutations, at most 8 amino acid mutations, at most 9 amino acid mutations, at most 10 amino acid mutations, or another suitable number as compared to the sequence of the venom or toxin that the peptide is derived from. In other cases, a peptide, or a functional fragment thereof, comprises at least 1 amino acid mutation, at least 2 amino acid mutations, at least 3 amino acid mutations, at least 4 amino acid mutations, at least 5 amino acid mutations, at least 6 amino acid mutations, at least 7 amino acid mutations, at least 8 amino acid mutations, at least 9 amino acid mutations, at least 10 amino acid mutations, or another suitable number as compared to the sequence of the venom or toxin that the peptide is derived from. In some embodiments, mutations can be engineered within a peptide to provide a peptide that has a desired charge or stability at physiological pH.

Peptides can be mutated to add function or remove function. For example, peptides and peptide-conjugates of the present disclosure can be mutated to retain, remove, or add the ability to bind to ion channels, or to promote agonizing or antagonizing ion channels, such as potassium channel binding that may occur with the peptide or peptide-conjugates (e.g., the potassium channel hERG). In some instances, it can be advantageous to remove potassium channel binding from a peptide used for delivery of an active agent. Mutations can include one or more N to Q, N to A, N to S, N to T, N to L amino acid substitutions, or any combination thereof, which can be made to decrease or eliminate peptide binding to the ion channel. Alternatively, mutations can include one or more S to G or S to R amino acid substitutions, or any combination thereof, which can be made to retain function or to modulate function during peptide binding to the ion channel. In some embodiments the peptides and peptide-drug conjugates of the present disclosure are mutated to minimize ion channel binding in order to minimize side effects or enhance the safety either in the target tissue or systemically.

In some embodiments, charge can play a role in kidney homing. Positively charged residues can increase binding of peptides to proximal tubule cells, to megalin (which is negatively charged), or can otherwise increase retention in the kidney (Janzer et al. Bioconjug Chem. 2016 Oct. 4, Geng et al. Bioconjug Chem. 2012 Jun. 20; 23(6):1200-10, Wischnjow et al. Bioconjug Chem. 2016 Apr. 20; 27(4):1050-7). The interaction of a peptide of this disclosure in solution and in vivo can be influenced by the isoelectric point (pI) of the peptide and/or the pH of the solution or the local environment it is in. The charge of a peptide in solution can impact the solubility of the protein as well as parameters such as biodistribution, bioavailability, and overall pharmacokinetics. Additionally, positively charged molecules can interact with negatively charged molecules. Positively charged molecules such as the peptides disclosed herein can interact and bind with molecules such as megalin and cubilin, or another cell surface receptor expressed by a cell of the proximal tubule, or a combination thereof. Positively charged residues can also interact with specific regions of other proteins and molecules, such as negatively charged residues of receptors or electronegative regions of an ion channel pore on cell surfaces. As such, the pI of a peptide can influence whether a peptide of this disclosure can efficiently home to the kidney. Identifying a correlation between pI and kidney homing can be an important strategy in identifying lead peptide candidates of the present disclosure. The p1 of a peptide can be calculated using a number of different methods including the Expasy p1 calculator and the Sillero method. The Expasy pI can be determined by calculating pKa values of amino acids as described in Bjellqvist et al., which were defined by examining polypeptide migration between pH 4.5 to pH 7.3 in an immobilized pH gradient gel environment with 9.2M and 9.8M urea at 15° C. or 25° C. (Bjellqvist et al. Electrophoresis. 14(10):1023-31 (1993)). The Sillero method of calculating pI can involve the solution of a polynomial equation and the individual pKas of each amino acid. This method does not use denaturing conditions (urea) (Sillero et al. 179(2): 319-35 (1989)) Using these pI calculation methods and quantifying the kidney to blood ratio of peptide signal after administration to a subject can be a strategy for identifying a trend or correlation in charge and kidney homing. In some embodiments, a peptide with a p1 above biological pH (˜pH 7.4) can exhibit efficient homing to kidney. In some embodiments, a peptide with a pI of at least 8, at least 9, at least 10, or at least 11 can efficiently home to kidney. In other embodiments, a peptide with a pI of 11-12 can home most efficiently to kidney. In certain embodiments, a peptide can have a pI of about 9. In other embodiments, a peptide can have a pI of 8-10. In some embodiments, more basic peptides can home more efficiently to kidney. In other embodiments, a high pI alone may not be sufficient to cause kidney homing of a peptide.

In some embodiments, the tertiary structure and electrostatics of a peptide of the disclosure can impact kidney homing. Structural analysis or analysis of charge distribution can be a strategy to predict residues important in biological function, such as kidney homing. For example, several peptides of this disclosure that home to kidney can be grouped into a structural class defined herein as “hitchins,” and can share the properties of disulfide linkages between C1-C4, C2-C5, and C3-C6. The folding topologies of peptides knotted through three disulfide linkages (C1-C4, C2-C5, and C3-C6), can be broken down into structural families based on the three-dimensional arrangement of the disulfides. Some cystine-dense peptides have the C3-C6 disulfide linkage passing through the macrocycle formed by the C1-C4 and C2-C5 disulfide linkages, hitchins have the C2-C5 disulfide linkage passing through the macrocycle formed by the C1-C4 and C3-C6 disulfide linkages, and yet other structural families have the C1-C4 disulfide linkage passing through the macrocycle formed by the C2-C5 and C3-C6 disulfide linkages. Variants of “hitchin” class peptides with preserved disulfide linkages at these cysteine residues, primary sequence identity, and/or structural homology can be a method of identifying or predicting other potential peptide candidates that can home to kidney. Additionally, members and related members of the calcin family of peptides can also home to kidney, despite having a distinct tertiary structure from the “hitchin” class of peptides. Calcin peptides are structurally a subset of the cystine-dense peptides, with cystine-dense disulfide connectivity and topology, but are further classified on the basis of functioning to bind and activate ryanodine receptors (RyRs). These receptors are calcium channels that act to regulate the influx and efflux of calcium in muscle (Schwartz et al. Br J Pharmacol 157(3):392-403. (2009)). Variants of the calcin family of peptides with preserved key residues can be one way to predict promising candidates that can home to kidney. In some embodiments, structural analysis of a peptide of this disclosure can be determined by evaluating peptides for resistance to degradation in buffers with various proteases or reducing agents. Structural analysis of the distribution of charge density on the surface of a peptide can also be a strategy for predicting promising candidates that can home to kidney. Peptides with large patches of positive surface charge (when at pH 7.5) can home to kidney.

The NMR solution structures, x-ray crystallography, or crystal structures of related structural homologs can be used to inform mutational strategies that can improve the folding, stability, and manufacturability, while maintaining the ability of a peptide to home to kidney. They can be used to predict the 3D pharmacophore of a group of structurally homologous scaffolds, as well as to predict possible graft regions of related proteins to create chimeras with improved properties. For example, this strategy can be used to identify critical amino acid positions and loops that can be used to design drugs with improved properties or to correct deleterious mutations that complicate folding and manufacturability for the peptides. These key amino acid positions and loops can be retained while other residues in the peptide sequences can be mutated to improve, change, remove, or otherwise modify function, homing, and activity of the peptide.

Additionally, the comparison of the primary sequences and the tertiary sequences of two or more peptides can be used to reveal sequence and 3D folding patterns that can be leveraged to improve the peptides and parse out the biological activity of these peptides. For example, comparing two different peptide scaffolds that home to kidney can lead to the identification of conserved pharmacophores that can guide engineering strategies, such as designing variants with improved folding properties. Important pharmacophore, for example, can comprise aromatic residues or basic residues, which can be important for binding.

Improved peptides can also be engineered based upon immunogenicity information, such as immunogenicity information predicted by TEPITOPE and TEPITOPEpan. TEPITOPE is a computational approach which uses position specific scoring matrix to provide prediction rules for whether a peptide will bind to 51 different HLA-DR alleles, and TEPITOPEpan is method that uses TEPITOPE to extrapolate from HLA-DR molecules with known binding specificities to HLA-DR molecules with unknown binding specificities based on pocket similarity. For example, TEPITOPE and TEPITOPEpan can be used to determine immunogenicity of peptides that home to kidney. Immunogenicity information can also be predicted using the program NetMHCII version 2. 3, which can determine the likelihood that a sequence might be presented as an immunogenic peptide via the major histocompatibility complex (MEW) presentation system of antigen presenting cells (APCs). (Nielson, M et al. BMC Bioinformatics, 8: 238 (2007); Nielsen, M. et al. BMC Bioinformatics, 10: 296 (2009)). This program can create an immunogenicity score by predicting the binding of a peptide to MEW alleles. Strong binding alleles and weak binding alleles in each major MEW allele group (DR, DQ, and DP) can be tallied separately. The number of peptides of a specific length within the sequence (e.g., a ‘core’ peptide that can be nine residues long) that are immunogenic can also be tallied. Comparison of peptides or ‘core’ peptides with high immunogenecity to peptides or ‘core’ peptides with low immunogenicity can guide engineering strategies for designing variants with decreased immunogenicity. Stronger binding peptides can be more likely to generate an immune response in patient carrying that given MEW alleles. Mutating stronger binding amino acids or peptides out of a peptide sequence can reduce the immunogenicity of the entire peptide. Another aspect of immunogenicity, in addition to whether a peptide binds to a patient's MEW allele, can be whether the patient's immune cells, such as a professional antigen presenting cells such as a macrophage, a B cell, or a dendritic cell, can process the peptide. A dendritic cell can take up a protein or peptide, and then can process a peptide, such as by cleaving to form a nine residue long peptide, which then can bind to the MEW and can be presented on the surface of the dendritic cell to the immune system's various T cells, including helper T cells and cytotoxic T cells, and thus can stimulate an immune response. The processing can involve peptide bond cleavage by enzymes and disulfide bond reduction, and thus a peptide or protein that is resistant to enzymatic cleavage and/or reduction can be resistant to processing and subsequent MEW presentation to the immune system. Therefore, having a peptide or protein that is resistant to enzymatic cleavage and/or reduction can reduce its immunogenic potential.

In some embodiments, a peptide of this disclosure can bind to interact with, modulate, antagonize, or agonize any of the below renal ion channels in TABLE 2 reproduced from Table 1 of Kuo et al. (Chem Rev. 2012 Dec. 12; 112(12): 6353-6372), which is incorporated herein by reference.

TABLE 2 Renal Ion Channels from Kuo et al. Protein (gene) name Distribution in kidney Ion affected Disease associated TRPC6 (Trpc6) Glomerulus Ca²⁺ Focal Segmental Glomerulosclerosis TRPM6 (Trpm6) Distal convoluted tubule Mg²⁺ Hypomagnesemia ClC-5 (CLCN5) Convoluted proximal tubule Cl⁻/H⁺ Dent's disease ClC-Kb (CLCNKB) Thick ascending loop of Cl⁻ Bartter syndrome Henle ROMK (KCNJ1) Thick ascending loop of K⁺ Bartter syndrome Henle; Distal nephron Kir4.1 (KCNJ10) Collecting duct K⁺ EAST syndrome ENaC (Scnn1a) Collecting duct Na⁺ Pseudohypoaldosteronism ENaC (Scnn1a) Collecting duct Na⁺ Liddle's syndrome Polycystin 2 (PKD2) Convoluted tubule Ca²⁺ Polycystic kidney disease

In some embodiments, a peptide of this disclosure can bind to, inter act with, modulate antagonize, or agonize any of the below renal ion channels in TABLE 3 reproduced from Table 1 of Zhou et al. (Am J Physiol Renal Physiol. 2016 Jun. 1; 310(11): F1157-F1167.), which is incorporated herein by reference.

TABLE 3 Renal Ion Channels from Zhou et al. Protein Human Gene Expression in Agonists and Function in the Relevant Kidney Name Name the Kidney Activators Kidney Diseases TRP family TRPC TRPC1 TRPC1, TRP1 MC PLC Regulates DN mesangial cell contractility TRPC3 TRPC3, TRP3 P, DCT, CD DAG, PLC Regulates SOCE Williams-Beuren in podocytes, syndrome Ca²⁺ reabsorption hypercalcemia, in DCT and renal fibrosis CD TRPC5 TRPC5, TRP5 P, JGC Intracellular Dysregulates Podocyte injury, Ca²⁺, podocyte actin glomerular disease lysophospholipids, cytoskeleton, oxidative degrades stress, synaptopodin, rosiglitazone, and activates riluzole, PLC Rac1 TRPC6 TRPC6, TRP6, P, CD PLC, DAG, Regulates FSGS, DN FSGS2 hyperforin, podocyte slit lysophosphatidyl- diaphragm choline, 20-HETE TRPV TRPV4 TRPV4, VR- ATL, TAL, Mechanical Regulates renal OAC, OTRPC DCT, CNT stress, warm osmolality and 4 (<33° C.), 4α- water PDD, reabsorption GSK1016790 A TRPV5 TRPV5, CAT2, DCT, CNT Constitutively Ca²⁺ reabsorption ECaC1 active, PKA- dependent phosphorylation, sheer stress, PIP₂ TRPP PKD1/PKD2 PKD1/PKD2 Epithelial Mechanical Activates G ADPKD complex cells of TAL, stress, protein signaling DCT intracellular cascades, Ca²⁺ (?) mechanosensor VGCC T-type VGCC Ca_(v)3.1 CACNA1G Afferent and Low voltage Regulates blood DN, fibrosis, efferent flow glomerular arterioles, hypertension MC, DCT, CD Ca_(v)3.2 CACNA1H Afferent and Low voltage Regulates efferent glomerular arterioles, filtration rate MC, L-type VGCC Ca_(v)1.2 CACNA1C Afferent and High voltage, Vasoconstriction, Glomerular efferent 1,4- modifies the hypertension, arterioles, dihydropyridines, formation of PKD (?) MC, DCT FPL- kidney cysts 64176 P-/Q-type VGCC Ca_(v)2.1 CACNA1A Afferent High voltage Depolarization- arterioles, MC mediated contraction in renal afferent arterioles TRP, transient receptor potential; VGCC, voltage-gated calcium channels; P, podocyte; MC, mesangial cell; PCT, proximal convoluted tubule; ATL, ascending thin limb; TAL, thick ascending limb; DCT, distal convoluted tubule; CNT, connecting tubule; CD, collecting duct; SOCE, store-operated Ca2+ entry; PIP₂, phosphatidylinositol 4,5-bisphosphate; JGC, juxtaglomerular cell; ADPKD, autosomal dominant polycystic kidney disease; DN, diabetic nephropathy; NDI, nephrogenic diabetes insipidus; FSGS, focal segmental glomerulosclerosis.

In some embodiments, a peptide of this disclosure can bind to, inter act with, modulate antagonize, or agonize any of the renal ion channels in Loudon et al. (Ann Clin Biochem. 2014 Jul.; 51(Pt 4):441-58), which is incorporated herein by reference. Such renal ion channels include NKCC2, ROMK, ClC-Kb, ClC-Ka, NCCT, TRPM6, TRPM7, Kv1.1, Kir4.1, ROMK1, Maxi-K, ENaC, PC1, PC2, and CLC-5, or any combination thereof.

Furthermore, multiple sequence alignment can also be used to inform mutational strategies using previously identified sequences, and thus providing a guide to making changes that would eliminate labile residues and immunogenic regions of a peptide sequence. Peptides can be evaluated for residues of potential biochemical instability and regions of potential immunogenicity. Then, a residue that can allow for greater peptide stability at a certain location in a peptide can be identified from a multiple sequence alignment. For example, a specific residue can be identified from a multiple sequence alignment as providing greater stability for a peptide at position previously identified as a possible risk for a significant rate of deamidation, cleavage, degradation, oxidation, hydrolysis, isomerization, disulfide exchange, racemization, beta elimination, or aggregation. This information can then be used to create peptides with greater stability or reduced immunogenicity.

In addition to utilizing co-crystal x-ray structures, NMR solution structures, and mutagenesis studies, a multiple alignment of peptide sequences can be used to identify specific amino acids or regions of high conservation that indicate an important interaction with a target or receptor (e.g., binding to a potassium channel protein) or are important for folding and structure or other properties. Once the conserved amino acid or region is identified, then amino acids replacements can be determined that maintain the important properties of the peptide, such as maintenance of the structure, reduction in immunogenicity, reduction in binding to an ion channel protein, increased stability, or any combination of thereof.

The multiple sequence alignment can also identify possible locations to add a tyrosine or tryptophan residue for spectrophotometric reporting. Incorporation of aromatic amino acids such as Tyrosine or Tryptophan into a peptide such as SEQ ID NO: 132, which otherwise contains only amino acids of low UV absorbance at 280 nm, can be analytically advantageous. Tyrosine and Tryptophan amino acids contain aromatic ring structures. These residues have distinct absorption and emission wavelengths and good quantum yields, as shown in TABLE 4 not present in other amino acids. Both Tyrosine and Tryptophan can provide a good ‘handle’ for analytical detection of a peptide in solution since UV absorbance in the 250-300 nm range and peptide fluorescence is specific for these aromatic molecules. While detection of a peptide such as SEQ ID NO: 132 relies on the absorbance of the peptide bond at 220 nm, where many other materials including minor impurities in solvents also often contribute to signal, the absorbance and fluorescence properties of Tryptophan and Tyrosine containing peptides can provide for a significantly more selective and sensitive detection. Thus incorporating an aromatic amino acid can create peptides better suited for concentration and purity measurements, which can be useful during analytics, process development, manufacturing, and other drug development and drug manufacturing activities. Incorporation can be achieved either through substitutions of one or more amino acids in the peptide to Tyr and/or Trp, insertion of Tyr and/or Trp into the peptide, or via addition of Tyr and/or Trp to the N-terminus or C-terminus of the peptide.

TABLE 4 Absorbance and Fluorescence Characteristics of Tryptophan and Tyrosine. Absorbance Fluorescence Amino Wavelength Absorbtivity Wavelength Quantum Acid (nm) (M*cm)⁻¹ (nm) Yield Tryptophan 280 5,600 348 0.20 Tyrosine 274 1,400 303 0.14

A peptide of this disclosure can bind to chloride, potassium, or sodium channels. The peptide can also bind to calcium or magnesium channels. The peptide can block potassium channels and/or sodium channels. In some embodiments, the peptide can block any one or more of such channels. In some embodiments, the peptide cannot interact with any of such channels or can be mutated to reduce or remove binding to any such channels. The peptide can block calcium or magnesium channels. In some embodiments, the peptide can activate any one or more of such channels. In still other embodiments, the peptide can be a potassium channel agonist, a potassium channel antagonist, a portion of a potassium channel, a sodium channel agonist, a sodium channel antagonist, a chloride channel agonist, a chloride channel antagonist, a calcium channel agonist, a calcium channel antagonist, a hadrucalcin, a theraphotoxin, a huwentoxin, a kaliotoxin, a cobatoxin, or a lectin. In some embodiments, the lectin can be SHL-Ib2. In some embodiments, the peptide can interact with, binds, inhibits, inactivates, or alters expression of ion channels or chloride channels. In some embodiments, the peptide can interact with an Nav1.7 ion channel. In some embodiments, the peptide can interact with a Kv 1.3 ion channel. In still other embodiments, the peptide interacts with proteases, matrix metalloproteinase, inhibits cancer cell migration or metastases, has antimicrobial activity, or has antitumor activity. In addition to acting on matrix metalloproteinases, the peptide can interact with other possible proteases (e.g., elastases). In some embodiments, a peptide of this disclosure can bind to multidrug resistance transporters. Peptide and peptide drug conjugate binding to and blocking multidrug resistance transporters can be used to treat bacterial infections or cancers of the kidney.

The present disclosure can also encompass multimers of the various peptides described herein. Examples of multimers include dimers, trimers, tetramers, pentamers, hexamers, heptamers, and so on. A multimer can be a homomer formed from a plurality of identical subunits or a heteromer formed from a plurality of different subunits. In some embodiments, a peptide of the present disclosure is arranged in a multimeric structure with at least one other peptide, or two, three, four, five, six, seven, eight, nine, ten, or more other peptides. In certain embodiments, the peptides of a multimeric structure each have the same sequence. In alternative embodiments, some or all of the peptides of a multimeric structure have different sequences.

The present disclosure further includes peptide scaffolds that, e.g., can be used as a starting point for generating additional peptides. In some embodiments, these scaffolds can be derived from a variety of cystine-dense peptides. Some suitable peptides for scaffolds can include, but are not limited to, chlorotoxin, brazzein, circulin, stecrisp, hanatoxin, midkine, hefutoxin, potato carboxypeptidase inhibitor, bubble protein, attractin, α-GI, α-GID, μ-PIIIA, ω-MVIIA, ω-CVID, χ-MrIA, ρ-TIA, conantokin G, contulakin G, GsMTx4, margatoxin, shK, toxin K, chymotrypsin inhibitor (CTI), and EGF epiregulin core.

In some embodiments, the peptide sequences of the disclosure are flanked by additional amino acids. One or more additional amino acids can, for example, confer a desired in vivo charge, isoelectric point, chemical conjugation site, stability, or physiologic property to a peptide.

Identifying sequence homology can be important for determining key residues that preserve kidney targeting function. For example, in some embodiments retention of conserved hydrophilic residues, such as N, Q, S, T, D, E, K, R, and H, can be important in preserving peptide kidney targeting function by keeping the peptide from sticking to albumin and such function also engineered into any variants that are made. In other embodiments, identification of basic amino acids such as Lys and/or Arg can important to binding and retention of a peptide in the kidney and such function also engineered into any variants that are made. Two or more peptides can share a degree of homology and share similar properties in vivo. For instance, a peptide can share a degree of homology with a peptide of the present disclosure. In some cases, a peptide of the disclosure can have up to about 20% pairwise homology, up to about 25% pairwise homology, up to about 30% pairwise homology, up to about 35% pairwise homology, up to about 40% pairwise homology, up to about 45% pairwise homology, up to about 50% pairwise homology, up to about 55% pairwise homology, up to about 60% pairwise homology, up to about 65% pairwise homology, up to about 70% pairwise homology, up to about 75% pairwise homology, up to about 80% pairwise homology, up to about 85% pairwise homology, up to about 90% pairwise homology, up to about 95% pairwise homology, up to about 96% pairwise homology, up to about 97% pairwise homology, up to about 98% pairwise homology, up to about 99% pairwise homology, up to about 99.5% pairwise homology, or up to about 99.9% pairwise homology with a second peptide. In some cases, a peptide of the disclosure can have at least about 20% pairwise homology, at least about 25% pairwise homology, at least about 30% pairwise homology, at least about 35% pairwise homology, at least about 40% pairwise homology, at least about 45% pairwise homology, at least about 50% pairwise homology, at least about 55% pairwise homology, at least about 60% pairwise homology, at least about 65% pairwise homology, at least about 70% pairwise homology, at least about 75% pairwise homology, at least about 80% pairwise homology, at least about 85% pairwise homology, at least about 90% pairwise homology, at least about 95% pairwise homology, at least about 96% pairwise homology, at least about 97% pairwise homology, at least about 98% pairwise homology, at least about 99% pairwise homology, at least about 99.5% pairwise homology, at least about 99.9% pairwise homology with a second peptide. Various methods and software programs can be used to determine the homology between two or more peptides, such as NCBI BLAST, Clustal W, MAFFT, Clustal Omega, AlignMe, Praline, or another suitable method or algorithm.

In still other instances, the variant nucleic acid molecules encoding a peptide of any one of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 529 can be identified by either a determination of the sequence identity or homology of the encoded peptide amino acid sequence with the amino acid sequence of any one of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 529, or by a nucleic acid hybridization assay. Such peptide variants can include nucleic acid molecules (1) that remain hybridized with a nucleic acid molecule having the nucleotide sequence encoded by any one of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 529 (or any complement of the previous sequences) under stringent washing conditions, in which the wash stringency is equivalent to 0.5×−2×SSC with 0.1% SDS at 55-65° C., and (2) that encode a peptide having at least 70%, at least 80%, at least 90%, at least 95% or greater than 95% sequence identity or homology to the amino acid sequence of any one SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 529. Alternatively, peptide variants of any one of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 529 can be characterized as nucleic acid molecules (1) that remain hybridized with a nucleic acid molecule having the nucleotide sequence encoding any one of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 529 (or any complement of the previous sequences) under highly stringent washing conditions, in which the wash stringency is equivalent to 0.1×−0.2×SSC with 0.1% SDS at 50-65° C., and (2) that encode a peptide having at least 70%, at least 80%, at least 90%, at least 95% or greater than 95% sequence identity or homology to the amino acid sequence of any one of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 529.

Percent sequence identity or homology can be determined by conventional methods. See, for example, Altschul et al., Bull. Math. Bio. 48:603 (1986), and Henikoff and Henikoff, Proc. Natl. Acad. Sci. USA 89:10915 (1992). Briefly, two amino acid sequences are aligned to optimize the alignment scores using a gap opening penalty of 10, a gap extension penalty of 1, and the “BLOSUM62” scoring matrix of Henikoff and Henikoff (Id.). The sequence identity or homology is then calculated as: ([Total number of identical matches]/[length of the longer sequence plus the number of gaps introduced into the longer sequence in order to align the two sequences])(100).

Additionally, there are many established algorithms available to align two amino acid sequences. For example, the “FASTA” similarity search algorithm of Pearson and Lipman is a suitable protein alignment method for examining the level of sequence identity or homology shared by an amino acid sequence of a peptide disclosed herein and the amino acid sequence of a peptide variant. The FASTA algorithm is described by Pearson and Lipman, Proc. Nat'l Acad. Sci. USA 85:2444 (1988), and by Pearson, Meth. Enzymol. 183:63 (1990). Briefly, FASTA first characterizes sequence similarity by identifying regions shared by the query sequence (e.g., SEQ ID NO: 530) and a test sequence that has either the highest density of identities (if the ktup variable is 1) or pairs of identities (if ktup=2), without considering conservative amino acid substitutions, insertions, or deletions. The ten regions with the highest density of identities are then rescored by comparing the similarity of all paired amino acids using an amino acid substitution matrix, and the ends of the regions are “trimmed” to include only those residues that contribute to the highest score. If there are several regions with scores greater than the “cutoff” value (calculated by a predetermined formula based upon the length of the sequence and the ktup value), then the trimmed initial regions are examined to determine whether the regions can be joined to form an approximate alignment with gaps. Finally, the highest scoring regions of the two amino acid sequences are aligned using a modification of the Needleman-Wunsch-Sellers algorithm (Needleman and Wunsch, J. Mol. Biol. 48:444 (1970); Sellers, Siam J. Appl. Math. 26:787 (1974)), which allows for amino acid insertions and deletions. Illustrative parameters for FASTA analysis are: ktup=1, gap opening penalty=10, gap extension penalty=1, and substitution matrix=BLOSUM62. These parameters can be introduced into a FASTA program by modifying the scoring matrix file (“SMATRIX”), as explained in Appendix 2 of Pearson, Meth. Enzymol. 183:63 (1990).

FASTA can also be used to determine the sequence identity or homology of nucleic acid molecules using a ratio as disclosed above. For nucleotide sequence comparisons, the ktup value can range between one to six, preferably from three to six, most preferably three, with other parameters set as described above.

Some examples of common amino acids that are a “conservative amino acid substitution” are illustrated by a substitution among amino acids within each of the following groups: (1) glycine, alanine, valine, leucine, and isoleucine, (2) phenylalanine, tyrosine, and tryptophan, (3) serine and threonine, (4) aspartate and glutamate, (5) glutamine and asparagine, and (6) lysine, arginine and histidine. The BLOSUM62 table is an amino acid substitution matrix derived from about 2,000 local multiple alignments of protein sequence segments, representing highly conserved regions of more than 500 groups of related proteins (Henikoff and Henikoff, Proc. Nat'l Acad. Sci. USA 89:10915 (1992)). Accordingly, the BLOSUM62 substitution frequencies can be used to define conservative amino acid substitutions that may be introduced into the amino acid sequences of the present invention. Although it is possible to design amino acid substitutions based solely upon chemical properties (as discussed above), the language “conservative amino acid substitution” preferably refers to a substitution represented by a BLOSUM62 value of greater than −1. For example, an amino acid substitution is conservative if the substitution is characterized by a BLOSUM62 value of 0, 1, 2, or 3. According to this system, preferred conservative amino acid substitutions are characterized by a BLOSUM62 value of at least 1 (e.g., 1, 2 or 3), while more preferred conservative amino acid substitutions are characterized by a BLOSUM62 value of at least 2 (e.g., 2 or 3).

Determination of amino acid residues that are within regions or domains that are critical to maintaining structural integrity can be determined. Within these regions one can determine specific residues that can be more or less tolerant of change and maintain the overall tertiary structure of the molecule. Methods for analyzing sequence structure include, but are not limited to, alignment of multiple sequences with high amino acid or nucleotide identity or homology and computer analysis using available software (e.g., the Insight II™ viewer and homology modeling tools; MSI, San Diego, Calif.), secondary structure propensities, binary patterns, complementary packing and buried polar interactions (Barton, G. J., Current Opin. Struct. Biol. 5:372-6 (1995) and Cordes, M. H. et al., Current Opin. Struct. Biol. 6:3-10 (1996)). In general, when designing modifications to molecules or identifying specific fragments determination of structure can typically be accompanied by evaluating activity of modified molecules.

Pairwise sequence alignment is used to identify regions of similarity that may indicate functional, structural and/or evolutionary relationships between two biological sequences (protein or nucleic acid). By contrast, multiple sequence alignment (MSA) is the alignment of three or more biological sequences. From the output of MSA applications, homology can be inferred and the evolutionary relationship between the sequences assessed. One of skill in the art would recognize as used herein, “sequence homology” and “sequence identity” and “percent (%) sequence identity” and “percent (%) sequence homology” have been used interchangeably to mean the sequence relatedness or variation, as appropriate, to a reference polynucleotide or amino acid sequence.

In some embodiments, the first two N-terminal amino acids of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 235, SEQ ID NO: 471-SEQ ID NO: 529, SEQ ID NO: 530-SEQ ID NO: 549, or SEQ ID NO: 570 (GS or GG) serve as a spacer or linker in order to facilitate conjugation or fusion to another molecule, as well as to facilitate cleavage of the peptide from such conjugated or fused molecules. In some embodiments, the peptide may not include the first two N-terminal amino acids shown in SEQ ID NO: 236-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 470 or SEQ ID NO: 550-SEQ ID NO: 569, or such N-terminal amino acids can be substituted by any other one or two amino acids, as shown in SEQ ID NO: 471-SEQ ID NO: 529. For example, in certain embodiments, the first two N-terminal amino acids (GS) of SEQ ID NO: 1 are substituted with GG as in SEQ ID NO: 471. As another example, in certain embodiments, the first two N-terminal amino acids (GG) of SEQ ID NO: 40 are substituted with GS as in SEQ ID NO: 523.

In some embodiments, the peptide sequence is flanked by additional amino acids. One or more additional amino acids can, for example, confer a desired charge under physiological conditions, isoelectric point, chemical conjugation site, stability, or physiologic property to a peptide. For instance, the amine in a lysine residue or the N-terminus can serve as a chemical conjugation site. Other lysine residues can be mutated out, such as by substitution with arginine, to provide a single site for amine conjugation.

The present disclosure encompasses various modifications to the peptides provided herein. In some embodiments, a peptide of the present disclosure contains or is modified to contain only one lysine residue, or no lysine residues. In some embodiments, some or all of the lysine residues in the peptide are replaced with arginine residues. In some embodiments, some or all of the methionine residues in the peptide are replaced by leucine or isoleucine. In some embodiments, some or all of the tryptophan residues in the peptide are replaced by phenylalanine or tyrosine. In some embodiments, some or all of the asparagine residues in the peptide are replaced by glutamine. In some embodiments, some or all of the cysteine residues in the peptide are replaced by serine to produce a linearized form of the peptide. In some embodiments, the N-terminus of the peptide is blocked, such as by an acetyl group. In some embodiments, the N-terminus of the peptide is blocked with pyroglutamic acid. Alternatively or in combination, in some instances, the C-terminus of the peptide is blocked, such as by an amide group. In some embodiments, the peptide is modified by methylation on free amines. For example, full methylation can be accomplished through the use of reductive methylation with formaldehyde and sodium cyanoborohydride.

At physiological pH, peptides can have a net charge, for example, of −5, −4, −3, −2, −1, 0, +1, +2, +3, +4, +5, +6, +7, +8, +9, or +10. When the net charge is zero, the peptide can be uncharged or zwitterionic. In some embodiments, the engineering of one or more mutations within a peptide yields a peptide with an altered isoelectric point, charge, surface charge, or rheology at physiological pH. Such engineering of a mutation to a peptide of the present disclosure (e.g., a peptide derived from a scorpion or spider) can change the net charge of the complex, for example, by decreasing the net charge by 1, 2, 3, 4, or 5, or by increasing the net charge by 1, 2, 3, 4, or 5.

In certain embodiments, the engineered mutation can facilitate the ability of the peptide to bind to renal tissue. Suitable amino acid modifications for improving the rheology and potency of a peptide can include conservative or non-conservative mutations. A peptide can comprise at most 1 amino acid mutation, at most 2 amino acid mutations, at most 3 amino acid mutations, at most 4 amino acid mutations, at most 5 amino acid mutations, at most 6 amino acid mutations, at most 7 amino acid mutations, at most 8 amino acid mutations, at most 9 amino acid mutations, at most 10 amino acid mutations, or another suitable number as compared to the sequence of the peptide scaffold (e.g., venom or toxin component) that the peptide is derived from. In other cases, a peptide, or a functional fragment thereof, comprises at least 1 amino acid mutation, at least 2 amino acid mutations, at least 3 amino acid mutations, at least 4 amino acid mutations, at least 5 amino acid mutations, at least 6 amino acid mutations, at least 7 amino acid mutations, at least 8 amino acid mutations, at least 9 amino acid mutations, at least 10 amino acid mutations, or another suitable number as compared to the sequence of the peptide scaffold (e.g., venom or toxin component) that the peptide is derived from. In some embodiments, mutations can be engineered within a peptide to provide a peptide that has a desired charge or stability at physiological pH.

In some embodiments, more than one peptide sequence is present on a particular peptide. For example, a peptide of the present disclosure can include sequences from at least 1, at least 2, at least 3, at least 4, at least 5, at least 6, at least 7, at least 8, at least 9, or at least 10 different peptides, or fragments thereof.

Peptide Properties for Renal Localization, Binding, and Internalization

The present disclosure provides peptides that can distribute to, home, target, be directed to, accumulate in, migrate to, be retained in, and/or bind to one or more specific regions, tissue, structures, regions, compartments, or cells of the kidney, collectively referred to herein as “renal tissue.” Examples of regions, tissue, structures, or cells of the kidney applicable to the embodiments presented herein include but are not limited to: the cortex region, the glomerulus, the glomerular filtrate (Bowman's space) tubular lumina, the proximal tubule, the S1, S2, and S3 segments, the medulla region, the descending tubule, the ascending tubule, the distal tubule, the loop of Henle, the Bowman's capsule, the renal interstitium, the renal microvasculature, vasa rectae, or any cells or cell types thereof.

In some embodiments, the peptides of the present disclosure interact with renal tissue of the subject, e.g., by binding to the renal tissue. The binding between the peptide and the renal tissue can be a specific binding interaction (e.g., a receptor-ligand interaction) or non-specific binding interaction (e.g., electrostatic interaction). For example, in certain embodiments, upon administration to a subject, a peptide of the present disclosure binds to a proximal tubule of the subject, e.g., a cell of the proximal tubule. As another example, in certain embodiments, upon administration to a subject, a peptide of the present disclosure binds to a glomerulus of the subject, e.g., a cell of the glomerulus. As another example, in certain embodiments, a peptide of the present disclosure binds to podocytes. In various embodiments, the peptides bind to receptors expressed by a renal cell. For instance, a peptide can bind to a cell surface receptor expressed by a cell of the proximal tubule, a megalin receptor, a cubulin receptor, or a combination thereof.

In some embodiments, the peptides are internalized by a cell of the renal tissue of the subject. The present disclosure encompasses various types of internalization mechanisms, including but not limited to pinocytosis, phagocytosis, endocytosis, receptor-mediated endocytosis, scavenging mechanisms, membrane penetration or translocation mechanisms, or combinations thereof. For example, a peptide can be internalized following binding to the cell or a receptor thereof, e.g., via receptor-mediated endocytosis.

Certain embodiments of the peptides described herein exhibit properties that enhance localization, binding, accumulation in, and/or internalization by renal tissues, regions, compartments, or cells. Examples of peptide properties that can be relevant to renal binding and internalization include but are not limited to isoelectric point, net charge, charge distribution, molecular weight, hydrodynamic radius, pH stability, hydrophilicity, and protein-protein binding.

For example, in various embodiments, the peptides of the present disclosure exhibit an isoelectric point (pI) favorable for renal localization, binding, and/or internalization. In certain embodiments, the pI of a peptide is less than or equal to about 2.0, less than or equal to about 2.5, less than or equal to about 3.0, less than or equal to about 3.5, 4.0, less than or equal to about 4.5, less than or equal to about 5.5, less than or equal to about 6.0, less than or equal to about 6.5, less than or equal to about 7.0, less than or equal to about 7.5, less than or equal to about 8.0, less than or equal to about 8.5, less than or equal to about 9.0, less than or equal to about 9.5, less than or equal to about 10.0, less than or equal to about 10.5, less than or equal to about 11.0, less than or equal to about 11.5, less than or equal to about 12.0, less than or equal to about 12.5, less than or equal to about 13.0, less than or equal to about 13.5, less than or equal to about 14.0, less than or equal to about 14.5, or less than or equal to about 15.0. In certain embodiments, the pI of a peptide is greater than or equal to about 2.0, greater than or equal to about 2.5, greater than or equal to about 3.0, greater than or equal to about 3.5, 4.0, greater than or equal to about 4.5, greater than or equal to about 5.5, greater than or equal to about 6.0, greater than or equal to about 6.5, greater than or equal to about 7.0, greater than or equal to about 7.5, greater than or equal to about 8.0, greater than or equal to about 8.5, greater than or equal to about 9.0, greater than or equal to about 9.5, or greater than or equal to about 10.0, greater than or equal to about 10.5, greater than or equal to about 11.0, greater than or equal to about 11.5, greater than or equal to about 12.0, greater than or equal to about 12.5, greater than or equal to about 13.0, greater than or equal to about 13.5, greater than or equal to about 14.0, greater than or equal to about 14.5, or greater than or equal to about 15.0. The pI of a peptide can be within a range from about 3.0 to about 10.0, within a range from about 3.0 to about 6.0, or within a range from about 4.0 to about 9.0.

In some embodiments, the pI (the pH at which the net charge of the peptide is zero) of the peptides of this disclosure can be calculated by the EMBOSS method. The pI value is the isoelectric point of fully reduced form of protein sequences. The value can be calculated with the Henderson-Hasselbalch equation using EMBOSS scripts and a pKa table provided by the European Bioinformatics Institute. The EMBOSS method of calculating pI has been described by Rice et al. (EMBOSS: the European Molecular Biology Open Software Suite. Trends Genet. 2000 Jun.; 16(6):276-7) and Carver et al. (The design of Jemboss: a graphical user interface to EMBOSS. Bioinformatics. 2003 Sep. 22; 19(14):1837-43). In some embodiments, peptides of the present disclosure with a pI value greater than 9 can have higher accumulation in the kidneys.

In some embodiments, the pI of the peptide influences its localization within the kidney. For example, in certain embodiments, higher pI values (e.g., greater than or equal to about 7.5) promote localization and/or binding to the glomerulus, while lower pI values (e.g., lower than 7.5) promote localization and/or binding to the proximal tubule. Accordingly, different localization patterns within the kidney can be achieved by varying the pI of the peptide. In certain embodiments, the osmotic concentration of the urine and/or urine flow rates have an impact on intratubular localization.

As another example, in various embodiments, the peptides of the present disclosure exhibit a charge distribution at neutral pH favorable for renal localization, binding, and/or internalization. In certain embodiments, the peptide exhibits a substantially uniform charge distribution. In alternative embodiments, the peptide exhibits a non-uniform charge distribution, e.g., including one or more regions of concentrated positive charge and/or one or more regions of concentrated negative charge. The charge distribution can impact the localization, binding and/or internalization of the peptide. For example, the glomerular capillary wall and/or slit processes are negatively charged, which in certain embodiments influences glomerular localization of middle sized positively charged molecules (e.g., having a mass-average molecular weight (Mw) within a range from about 30 kDa to about 60 kDa), while being less likely to influence localization of smaller molecules (e.g., having a Mw less than 30 kDa) such as the peptides of the present disclosure. In certain embodiments, the charge distribution of the peptide influences electrostatic interactions with a target, e.g., the megalin/cubulin receptor.

In yet another example, in various embodiments, the peptides of the present disclosure exhibit a molecular weight favorable for renal targeting, localization, binding, accumulation, and/or internalization. In certain embodiments, the peptide comprises a mass-average molecular weight (Mw) less than or equal to about 1 kDa, less than or equal to about 2 kDa, less than or equal to about 3 kDa, less than or equal to about 4 kDa, less than or equal to about 5 kDa, less than or equal to about 6 kDaor less than or equal to about 10 kDa, less than or equal to about 20 kDa, less than or equal to about 30 kDa, less than or equal to about 40 kDa, less than or equal to about 50 kDa, less than or equal to about 60 kDa, or less than or equal to about 70 kDa. In certain embodiments, the peptide comprises a Mw within a range from about 0.5 kDa to about 50 kDa, or within a range from about 0.5 kDa to about 60 kDa.

In some embodiments, molecules (e.g., proteins or peptides) having relatively low Mw (e.g., less than or equal to about 1 kDa, less than or equal to about 2 kDa, less than or equal to about 3 kDa, less than or equal to about 4 kDa, less than or equal to about 5 kDa, less than or equal to about 10 kDa, less than or equal to about 20 kDa, less than or equal to about 30 kDa, or less than or equal to about 60 kDa) are rapidly targeted to, localized, bound, accumulated, and/or internalized by the kidney. In certain embodiments, low Mw molecules are freely filtered, presented to the proximal tubules of the kidney, and optionally taken up by megalin/cubulin receptors. In certain embodiments, low molecular weight molecules undergo endocytic reabsorption via the megalin/cubulin pathway and are then trafficked to renal tubular lysosomes for processing. In some embodiments, molecules (e.g., proteins or peptides) having higher Mw (e.g., greater than about 70 kDa) are generally excluded from glomerular filtration, but can still be able to achieve interstitial localization via the microcirculation.

In a further example, in various embodiments, the peptides of the present disclosure exhibit stability at pH values favorable for renal localization, binding, and/or internalization. A peptide can be considered to be stable at a certain pH if it is capable of performing its functional or therapeutic effect, is soluble, is resistant to protease degradation, is resistant to reduction, retains secondary or tertiary structure, or a combination thereof. In certain embodiments, the peptide is stable at pH values less than or equal to about 3.0, less than or equal to about 3.5, 4.0, less than or equal to about 4.5, less than or equal to about 5.5, less than or equal to about 6.0, less than or equal to about 6.5, less than or equal to about 7.0, less than or equal to about 7.5, less than or equal to about 8.0, less than or equal to about 8.5, less than or equal to about 9.0, less than or equal to about 9.5, or less than or equal to about 10.0. In certain embodiments, the peptide is stable at pH values greater than or equal to about 3.0, greater than or equal to about 3.5, 4.0, greater than or equal to about 4.5, greater than or equal to about 5.5, greater than or equal to about 6.0, greater than or equal to about 6.5, greater than or equal to about 7.0, greater than or equal to about 7.5, greater than or equal to about 8.0, greater than or equal to about 8.5, greater than or equal to about 9.0, greater than or equal to about 9.5, or greater than or equal to about 10.0. In certain embodiments, the peptide is stable at pH values within a range from about 3.0 to about 5.0, and/or within a range from about 5.0 to about 7.0.

As previously discussed, in some embodiments, the disulfide knot structure of cystine-dense peptides confers improved stability over a wide range of pH values, which can be advantageous for renal applications. For example, stability at low pH values can be advantageous in order to avoid cast formation leading to intratubular obstruction. In some embodiments, cast formation occurs via co-precipitation of proteins with an endogenously produced glycoprotein known as Tamm Horsall protein. In certain embodiments, this precipitation is affected by urinary pH and osmolality, as precipitation typically occurs under acidic conditions (e.g., pH less than about 5) and high salt concentrations and/or osmolality. Alternatively or in combination, stability at low pH value can reduce or prevent lysosomal degradation, which can improve delivery precision and avoid broader cellular or systemic toxicity.

Chemical Modifications

A peptide can be chemically modified one or more of a variety of ways. For example, N-methylation is one example of methylation that can occur in a peptide of the disclosure. In some embodiments, the peptide can be mutated to add function, delete function, or modify the in vivo behavior. One or more loops between the disulfide linkages can be modified or replaced to include active elements from other peptides (such as described in Moore and Cochran, Methods in Enzymology, 503, p.223-251, 2012). Amino acids can also be mutated, such as to increase half-life or bioavailability, modify, add or delete binding behavior in vivo, add new targeting function, modify surface charge and hydrophobicity, or allow conjugation sites. N-methylation is one example of methylation that can occur in a peptide of the disclosure. In some embodiments, the peptide can be modified by methylation on free amines. For example, full methylation can be accomplished through the use of reductive methylation with formaldehyde and sodium cyanoborohydride.

A chemical modification can, for instance, extend the terminal half-life, the absorption half-life, the distribution half-life of a peptide, or change the biodistribution or pharmacokinetic profile. A chemical modification can comprise a polymer, a polyether, polyethylene glycol, a biopolymer, a polyamino acid, a fatty acid, a dendrimer, an Fc region, a simple saturated carbon chain such as palmitate or myristolate, sugars, hyaluronic acid, or albumin. The chemical modification of a peptide with an Fc region can be a fusion Fc-peptide. A polyamino acid can include, for example, a polyamino acid sequence with repeated single amino acids (e.g., polyglycine), and a polyamino acid sequence with mixed polyamino acid sequences (e.g., gly-ala-gly-ala (SEQ ID NO: 634)) that can or cannot follow a pattern, or any combination of the foregoing.

In some embodiments, the peptides of the present disclosure may be modified such that the modification increases the stability and/or the half-life of the peptides. In some embodiments, the attachment of a hydrophobic moiety, such as to the N-terminus, the C-terminus, or an internal amino acid, can be used to extend half-life of a peptide of the present disclosure. In other embodiments, the peptide of the present disclosure can include post-translational modifications (e.g., methylation and/or amidation), which can affect, e.g., serum half-life. In some embodiments, simple carbon chains (e.g., by myristoylation and/or palmitylation) can be conjugated to the peptides. In some embodiments, for example, the simple carbon chains may render conjugated peptides easily separable from unconjugated material. For example, methods that may be used to separate the desired peptides of the invention from unconjugated material include, but are not limited to, solvent extraction and reverse phase chromatography. In some embodiments, lipophilic moieties can be conjugated to the peptide and can extend half-life through reversible binding to serum albumin. Moreover, the conjugated moieties can, e.g., be lipophilic moieties that extend half-life of the peptides through reversible binding to serum albumin. In some embodiments, the lipophilic moiety can be cholesterol or a cholesterol derivative including cholestenes, cholestanes, cholestadienes and oxysterols. In some embodiments, the peptides can be conjugated to myristic acid (tetradecanoic acid) or a derivative thereof. In other embodiments, the peptides of the present disclosure are coupled (e.g., conjugated) to a half-life modifying agent. Examples of half-life modifying agents include but are not limited to: a polymer, a polyethylene glycol (PEG), a hydroxyethyl starch, polyvinyl alcohol, a water soluble polymer, a zwitterionic water soluble polymer, a water soluble poly(amino acid), a water soluble polymer of proline, alanine and serine, a water soluble polymer containing glycine, glutamic acid, and serine, an Fc region, a fatty acid, palmitic acid, antibodies, or a molecule that binds to albumin.

In some embodiments, the first two N-terminal amino acids (GS or GG) of SEQ ID NO: 1-SEQ ID NO: 41, SEQ ID NO: 471-SEQ ID NO: 529, SEQ ID NO: 42-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 235, or SEQ ID NO: 530-SEQ ID NO: 549 can serve as a spacer or linker in order to facilitate conjugation or fusion to another molecule, as well as to facilitate cleavage of the peptide from such conjugated or fused molecules. In some embodiments, the peptides of the present disclosure can be conjugated to other moieties that can modify or effect changes to the properties of the peptides.

Active Agent Conjugates

Peptides according to the present disclosure can be conjugated or fused to a peptide biological agent or other agent comprising amino acids (e.g., an antibody or antibody fragment, receptor or receptor fragment, ligand or ligand fragment, hormone or hormone fragment, growth factors and growth factor fragments, biological toxins and fragments thereof, or other active portion of a peptide), a protein, a peptide, or to a small molecule, RNA, DNA, or other active agent molecular structure for use in the treatment of renal diseases, disorders, or injuries. A peptide active agent conjugate can be a peptide conjugated to an active agent by any mechanism described herein. For example, a peptide can be covalently conjugated to an active agent to form a peptide active agent conjugate. A peptide can be chemically conjugated to an active agent to form a peptide active agent conjugate. A peptide and active agent can be expressed as a fusion protein to form a peptide active agent conjugate. For example, an antibody or fragment thereof and a peptide can be expressed as a fusion protein to form a peptide active agent conjugate. For example, in certain embodiments, a peptide as described herein can be fused to another molecule, such as an active agent that provides a functional capability. The active agent can function as a renal therapeutic agent, a renal protective agent, or renal prophylactic agent. A peptide can be conjugated with an active agent through expression of a vector containing the sequence of the peptide with the sequence of the active agent. In various embodiments, the sequence of the peptide and the sequence of the active agent are expressed from the same Open Reading Frame (ORF). In various embodiments, the sequence of the peptide and the sequence of the active agent can comprise a contiguous sequence. Various vectors and recombinant systems known in the art can be employed to make such fusion peptides. The peptide and the active agent can each retain similar functional capabilities in the fusion peptide compared with their functional capabilities when expressed separately.

Furthermore, for example, in certain embodiments, the peptides described herein are attached to another molecule, such as an active agent that provides a functional capability. In some embodiments, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 active agents can be linked to a peptide. Multiple active agents can be attached by methods such as conjugating to multiple lysine residues and/or the N-terminus, or by linking the multiple active agents to a scaffold, such as a polymer or dendrimer and then attaching that agent-scaffold to the peptide (such as described in Yurkovetskiy, A. V., Cancer Res 75(16): 3365-72 (2015)).

Described herein are active agents that can be conjugated to the peptides of the present invention for use in kidney disorders. In some embodiments, certain compounds or drugs are appropriate for use in kidney disorders. In some embodiments, certain drug classes may be preferred for specific treatment depending on the indication or disorder. As described herein, it is understood that certain active agents are described in a non-limiting exemplary manner for use in treatments of kidney indications. One or more of such active agents can be conjugated to a peptide of the present invention alone or in combination with one or more detectable agents described herein. In some embodiments, active agents that can be conjugated to any peptide of this disclosure can be classified by mechanism. For example, active agents can belong to the class of anti-inflammatory drugs, immunosuppressive (immune suppression) drugs, analgesics/pain relief drugs, cell depleting agents/apoptosis modifiers, and tissue normalization (disease modifying) drugs.

Anti-inflammatory active agents can include, but are not limited to, corticosteroids, glucocorticoids, nonsteroidal anti-inflammatory drugs (NSAIDs), biologics, and other small molecules. Examples of corticosteroid active agents that can be conjugated to any peptide of this disclosure for delivery to the kidneys include triamcinolone, dexamethasone, budesonide, and triamcinolone acetonide. Examples of NSAID active agents that can be conjugated to any peptide of this disclosure for delivery to the kidneys include naproxen and ibuprofen. Other active agents can include acetylsalicylic acid and acetaminophen. NSAID active agents can be further classified into COX2 inhibitors. An example of a COX2 inhibitor active agent directed to a prostaglandin pathway that can be conjugated to any peptide of this disclosure for delivery includes celecoxib. An example of a COX2 inhibitor active agent with anti-leukotriene receptor antagonist that can be conjugated to any peptide of this disclosure for delivery includes montelukast. An example of a COX2 inhibitor active agent that can be conjugated to any peptide of this disclosure for delivery to the kidneys includes iguratimod. Biologic active agents can be further classified into active agents that are IL-1 family inhibitors, IL-17 or IL-23 pathway inhibitors, IL-6 family inhibitors, interferon receptor inhibitors, tumor necrosis factor (TNF) inhibitors, RANK pathway inhibitors, B cell inhibitors, anti-IgE active agents, and co-stimulation inhibitors. An example of an IL-1 family inhibitor active agent that can be conjugated to any peptide of this disclosure for delivery includes anakinra. An example of an IL-17/IL-23 pathway inhibitor active agent that can be conjugated to any peptide of this disclosure for delivery includes secukinumab. An example of an IL-6 family inhibitor active agent that can be conjugated to any peptide of this disclosure for delivery to the kidneys includes sirukumab. An example of an interferon receptor inhibitor active agent that can be conjugated to any peptide of this disclosure for delivery to the kidneys includes anifrolumab. An example of a TNF inhibitor active agent that can be conjugated to any peptide of this disclosure for delivery includes infliximab or etanercept. An example of a RANK pathway inhibitor active agent that can be conjugated to any peptide of this disclosure for delivery includes denosumab. An example of a B cell inhibitor active agent that can be conjugated to any peptide of this disclosure for delivery to the kidneys includes rituximab. An example of an anti-IgE active agent that can be conjugated to any peptide of this disclosure for delivery to the kidneys includes omalizumab. An example of a co-stimulation inhibitor active agent that can be conjugated to any peptide of this disclosure for delivery includes abatacept.

Pain relief active agents can include, but are not limited to analgesics, counter-irritants, and pain receptor blocking drugs. Analgesics can be further classified into non-narcotic agents and narcotic agents. An example of a non-narcotic active agent that can be conjugated to any peptide of this disclosure for delivery includes acetaminophen. An example of a narcotic active agent that can be conjugated to any peptide of this disclosure for delivery to the kidneys includes oxycodone. Counter-irritant active agents can be further classified as natural products. An example of a counter-irritant active agent that can be conjugated to any peptide of this disclosure for delivery include capsaicin, piperine, mustard oil, eugenol, and curcumin, and capsaicin-like molecules like resiniferatoxin (RTX). Pain receptor blocking active agents can be further classified as TRPV4 inhibitors. An example of a TRPV4 inhibitor active agent that can be conjugated to any peptide of this disclosure for delivery includes GSK2193874.

Apoptosis modifier active agents can include, but are not limited to, biologics and small molecules. Biologic apoptosis modifier active agents can be further classified as Fas/FasL inhibitors, TNF/TNFR inhibitors, TRAIL/TRAILR inhibitors, TWEAK/Fn14 inhibitors, IL-1 inhibitors, IL-1 receptor antagonists, growth factors, and sclerostin inhibitors. An example of a TNF/TNFR inhibitor active agent that can be conjugated to any peptide of this disclosure for delivery includes infliximab. An example of a TRAIL/TRAILR inhibitor active agent that can be conjugated to any peptide of this disclosure for delivery includes osteoprotegrin. An example of a TWEAK/Fn14 inhibitor active agent that can be conjugated to any peptide of this disclosure for delivery to the kidneys includes BIIB023. An example of an IL-1 receptor antagonist that can be conjugated to any peptide of this disclosure for delivery includes anakinra. An example of a growth factor active agent that can be conjugated to any peptide of this disclosure for delivery includes IGF-1. An example of a growth factor active agent that can be conjugated to any peptide of this disclosure for delivery to the kidneys includes EGF. An example of a sclerostin inhibitor active agent that can be conjugated to any peptide of this disclosure for delivery includes romosozumab. Small molecule apoptosis modifier active agents can be further classified as caspase inhibitors, iNOS inhibitors, surfactants, and bisphosphonates. An example of a caspase inhibitor active agent that can be conjugated to any peptide of this disclosure for delivery includes ZVAD-fmk. An example of an iNOS inhibitor active agent that can be conjugated to any peptide of this disclosure for delivery include S-methylisothiourea. An example of a surfactant active agent that can be conjugated to any peptide of this disclosure for delivery to the kidneys include P188. Moreover, the known class of drugs called senotherapeutics, also referred to as senolytics or senolytic drugs or senolytic compounds, refers to small molecules that can selectively induce death of senescent cells and for example by directly or indirectly inducing apoptosis in senescent cells. In addition, senolytics may also act via non-apoptotic mechanisms of cell death including by necroptis, autophagic cell death, pyroptis and caspase-independent cell death (Journal of Cell Science 127; 2135-2144 (2014)). Such drugs can attenuate age-related deterioration of tissues or organs. Examples of drugs that can be conjugated to any peptide of this disclosure to induce apoptosis or induce cell death via non-apoptotic mechanisms include quercetin, dasatinib, bortezomib, carfilzomib, and navitoclax amongst other compounds disclosed herein. Additional examples are metformin, rapamycin, ABT-263, ABT-737, mTOR modulators, dasatinib, molecules that interact with FOXO, such as FOXO4 peptide (Everts, “Can we hit the snooze button” Chemical and Engineering News, 95(10), 30-35,2017, Molecules that perturb the FOXO4 interaction with p53, such as a FOXO4 peptide (Cell. 169(1): 132-147 (2017)). Other examples include dietary flavonols, small interfering RNA, or a rapamycin analog such as RAD001. A further example of an active agent that can be linked to any peptide of this disclosure is dimethyl fumarate, which can be used for psoriatic arthritis or kidney fibrosis. Additional active agents are described in the following references: Aging Cell. 2015 Aug.; 14(4):644-58. doi: 10.1111/ace1.12344. Epub 2015 Apr. 22. Kirkland J L (2013b) Translating advances from the basic biology of aging into clinical application. Exp. Gerontol. 48, 1-5, Kirkland J L, Tchkonia T (2014) Clinical strategies and animal models for developing senolytic agents. Exp. Gerontol. 2014 Oct. 28. pii: S0531-5565(14)00291-5, Tchkonia T, Zhu Y, van Deursen J, Campisi J, Kirkland J L (2013) Cellular senescence and the senescent secretory phenotype: therapeutic opportunities. J. Clin. Invest. 123, 966-972, WO2016118859, WO2016118859, Pharmgenomics Pers Med. 2015; 8: 23-33, Ren et al. Sci Rep. 2016 Apr. 7; 6:23968, Swanson et al. Nat Rev Rheumatol. 2009 Jun.; 5(6): 317-324, Oh et al. PLoS One. 2012; 7(10): e45870, and Adebajo, Ade, Wolf-Henning Boehncke, Dafna D. Gladman, and P J. Mease. Psoriatic Arthritis and Psoriasis: Pathology and Clinical Aspects., 2016. Internet resource.

Tissue normalization (disease modifying) active agents can include, but are not limited to, biologics and small molecules. Biologic active agents can be further classified as chemokines (e.g. for stem cell recruitment) and growth factors. An example of a tissue normalization chemokine active agent that can be conjugated to any peptide of this disclosure for delivery to the kidney includes MIP-3α. An example of a tissue normalization growth factor active agent that can be conjugated to any peptide of this disclosure for delivery includes BMP-2 and BMP-7. Small molecule active agents can be further classified as flavonoids, ACE inhibitors, and anti-proliferative active agents. An example of a tissue normalization flavonoid active agent that can be conjugated to any peptide of this disclosure for delivery to the kidney includes icariin. An example of a tissue normalization ACE inhibitor active agent that can be conjugated to any peptide of this disclosure for delivery to the kidneys includes captopril. An example of a tissue normalization anti-proliferative active agent that can be conjugated to any peptide of this disclosure for delivery includes methotrexate.

TABLES 5 and 6 describe active agents for treatment of a kidney disorder that can be conjugated to any peptide of the present disclosure to form peptide-drug conjugates.

TABLE 5 Active Agents for Treatment of Kidney Disorders Active Agent Class Active Agent IL-6 Receptor Modulators Tocilizumab IL-6 Receptor Modulators Sarilumab IL-6 Receptor Modulators ALX-0061 IL-6 Receptor Modulators Sirukumab IL-6 Receptor Modulators Clazakizumab IL-6 Receptor Modulators Olokizumab IL-6 Receptor Modulators MEDI5117 IL-17 Antagonists Secukinumab IL-17 Antagonists Brodalumab IL-17 Antagonists Ixekizumab Antagonists of p40 Subunit of IL- Ustekinumab 12/IL-23 Antagonists of p40 Subunit of IL- Briakinumab 12/IL-23 Antagonists of p19 Subunit of IL-23 Tildrakizumab Antagonists of p19 Subunit of IL-23 Guselkumab IL-23 Antagonists Soluble IL-23 (or cytokine-binding homology region of soluble IL-23) IL-1 Antagonists Canakinumab IL-1 Antagonists Rilonacept IL-1 Antagonists Gevokizumab IL-1 Antagonists LY2189102 IL-1 Antagonists Lentiviral-mediated RNAi IL-12 Antagonists IL-1 Receptor Antagonists Anakinra IL-1 Receptor Antagonists MEDI-8968 IL-1 Receptor Antagonists AMG-108 IL-1 Receptor Kineret Interleukins/Pro-Inflammatory Pro-inflammatory IL-1α or IL-1β Cytokines Interleukins IL-8 Interleukins IL-15 Interleukins IL-18 Interleukins IL-4 Interleukins IL-10 Interleukins IL-13 Interleukins IL-17 p38 Inhibitors VX-745 p38 Inhibitors BIRB 796 p38 Inhibitors SCIO-469 p38 Inhibitors VX-702 p38 Inhibitors Pamapimod p38 Inhibitors ARRY-797 Corticosteroids 17-monopropionate Corticosteroids Desciclesonide Corticosteroids Flunisolide Corticosteroids 22-hydroxy intermediate budesonide derivative Corticosteroids 6β-hydroxy budesonide derivative Corticosteroids Δ6-budesonide derivative Corticosteroids 23-hydroxy budesonide derivative Corticosteroids 16α-butryloxyprednisolone budesonide derivative Corticosteroids 16α-hydroxyprednisolone budesonide derivative Corticosteroid (Beclomethasone) QVAR inhalation Corticosteroid (Budesonide) pulmicort respules Corticosteroid Flovent HFA 44 Corticosteroid (Mometasone) Asmanex HFA Corticosteroid (Mometasone) Budesonide symbicort Corticosteroid Tixocortol pivalate Corticosteroid Ciclesonide Glucocorticoids 21-nortriamcincolone acetonide Glucocorticoids Δ6-triamcinolone Glucocorticoids 6b-hydroxy triamcinolone acetonide Glucocorticoids 21-carboxy triamcinolone acetonide Glucocorticoids 6b-OH, 21-COOH triamcinolone acetonide Glucocorticoids 6α fluorocortisol Glucocorticoids 9α fluorocortisol Glucocorticoids Δ1-dehydro configuration in prednisolone Glucocorticoids 16-methylene dexamethasone derivative Glucocorticoids 16α-methyl dexamethasone derivative Glucocorticoids 16β-methyl betamethasone derivative Glucocorticoids/Mineralocorticoids Cortisol Glucocorticoids/Mineralocorticoids Betamethasone Glucocorticoid Fluticasone propionate Steroid (flunisolide) Aerobid Steroid (flunisolide) Aerobid-M Steroid (flunisolide) Aerospan Steroid (Flunisolide) Fluticasone Furoate Steroid (Fluticasone) Flovent HFA 110 Steroid (Fluticasone) Flovent HFA 220 Steroid (Fluticasone) Flovent Diskus 50 Steroid (Fluticasone) Asmanex Steroid Betamethasone acetate Steroid Betamethasone sodium phosphate Steroid Betamethasone valerate Steroid Beclomethasone dipropionate Local Anesthetic procaine hydrochloride Local Anesthetic novacain Anesthetic bupivacaine hydrochloride Anesthetic lidocaine hydrochloride Local Anesthetic ropivacaine hydrochloride Analgesics Morphine Analgesics Fentanyl Quinazolines Feitinib/Iressa Quinazolines Sorafenib/Nexavar Quinazolines Lapatinib ditosylate/Tykerb/Tyverb Quinazolines Sunitinib/Sutent Quinazolines Bortezomib/Velcade/Cytomib Quinazolines Everolimus/Temsirolimus Quinazolines Inhibitors of IAPS Quinazolines Activators of caspase pathway Quinazolines Activators of AKT pathway Quinazolines Propylpeptidase inhibitors Quinazolines Activators of p53 Quinazolines Inhibitors of anti-apoptotic protein inhibitors Prolyl Hydroxylase (PHD) Dimethyloxalylglycine (DMOG) Inhibitors Prolyl Hydroxylase (PHD) L-mimosine (L-mim) Inhibitors Aptamers Peptide aptamers Aptamers RNA aptamer A-p50 Aptamers Peptide A aptamer TrxLef1D Aptamers Aptamer E07 Aptamers Aptamer gemcitabine polymers Aptamers RAGE Aptamers Pegaptanib Proteosome Inhibitors Bortezomib Proteosome Inhibitors Carfilzomib Second Generation Proteosome Ixazomib Inhibitors Second Generation Proteosome Delanzomib Inhibitors Second Generation Proteosome Oprozomib Inhibitors Second Generation Proteosome Marizomib Inhibitors Apoptosis Inhibitors FLIP agonist Apoptosis Inhibitors nitric oxide synthase inhibitors Apoptosis Inhibitors caspase-3 inhibitors (Z-DEVD-fmk (SEQ ID NO: 635)) Apoptosis Inhibitors caspase-9 inhibitors (Z-LEHD-fmk (SEQ ID NO: 636)) Apoptosis Inhibitors Sclerostin antagonists Apoptosis Inhibitors/Growth Factor IGF-1 BCL-2 Agonist Apoptosis Inhibitors Oblimersen BCL-2 Agonist Apoptosis Inhibitors GX01 series of compounds BCL-2 Agonist Apoptosis Inhibitors BCL-2 small molecule antagonists BCL-2 Agonist Apoptosis Inhibitors Tetraocarcin-A derivatives BCL-2 Agonist Apoptosis Inhibitors Chelerythrine BCL-2 Agonist Apoptosis Inhibitors Antimycin A derivatives BCL-2 Agonist Apoptosis Inhibitors HA14-1 BCL-2 Agonist Apoptosis Inhibitors Synthetic compound antagonist of BH3 BCL-2 Agonist Apoptosis Inhibitors Genasense BCL-2 Agonist Apoptosis Inhibitors ISIS 22783 BCL-2/BCL-XL Agonist Apoptosis Bispecific Antisense Inhibitors Proapoptotic BCL-2 Targeting Bax, Bak, Bid, Bad-derived BH3 Peptides Drugs Proapoptotic BCL-2 Targeting SAHBs Drugs Proapoptotic BCL-2 Targeting BH3Is Drugs BCL-2/BCL-XL Agonist Apoptosis ABT-737 Inhibitors BCL-X Inhibitors Apoptosis Modifiers Caspase-1 Inhibitors Apoptosis Modifiers Caspase-8 Inhibitors Pan-caspase Caspase Inhibitor IDN-6556 Pan-caspase Caspase Inhibitor IDN-6734 Pan-caspase Caspase Inhibitor VX-799 Pan-caspase Inhibitor MX1013 Pan-caspase Caspase Inhibitor M-920 Pan-caspase Caspase Activator MX-2060 derivatives Pan-caspase Caspase Activators Small-molecule compounds Pan-caspase Caspase Activators RGD peptides Pan-caspase inhibitors ZVAD-fmk Caspase-1 ICE Inhibitors IDN-11104 Caspase-1 ICE Inhibitors VX-756 Caspase-3 Inhibitors M-826 Caspase-3 Inhibitors M-791 Caspase-3 Inhibitors Immunocasp-3 Caspase-3 Inhibitors Ad-G/iCasp3 Caspase-3 Inhibitors PEF-F8-CP3 Caspase-6 Inhibitors Immunocasp-6 Caspase-9 Inhibitors FKBP12/caspase-9 fusion protein IAP Antagonists BIR3 antagonists XIAP Antagonists Capped tripeptide XIAP Antagonists XIAP Antagonists Smac-mimetic compounds XIAP Antagonists AEG35156/GEM ®640 XIAP Inhibitors Embelin XIAP Inhibitors XIAP antisense and RNA constructs XIAP/cIAP-1/cIAP-2 Inhibitors Small molecule SMAC mimetics IAP/Caspase Inhibitors HIV-Tat/polyarginine-conjugated SMAC peptides BIR2/Caspase-3 Inhibitors TWX024 BIR2 Inhibitors Polyphenylurea derivatives Survivin Targeting Drugs LY2181308 Survivin Targeting Drugs Ad-Survivin T34A Xanthine Oxidase Inhibitors Allopurinol Xanthine Oxidase Inhibitors Febuxostat Xanthine Oxidase Inhibitors Zyloprin Growth Factor bFGF Growth Factor IGF Growth Factor TFG-beta Growth Factor BMP-2 Growth Factor BMP-9 Growth Factor BMP-13 Growth Factor BMP-7 Growth Factor BMP-3 inhibitors Growth Factor TFG-β1 Growth Factor OP-1 Growth Factor PDGF Growth Factor PTH Growth Factor PTHrP Growth Factor MIP-3α Growth Factor FGF Growth Factor FGF-2 Growth Factor FGF-18 Growth Factor TGF-β3 Growth Factor VEGF Growth Factor Wnt proteins Growth Factor EGF Growth Factor GM-CSF Flavonoid Icariin Flavonoid Quercetin Tyrosine Kinase Inhibitor (Lck/Btk Dasatinib Inhibitor) TRPV4 Activators G5K1016790A TRPV4 Activators 4alpha-PDD TRPV4 Inhibitors HC-067047 TRPV4 Inhibitors GSK2193874 NSAID Ampion NSAID Phenylbutazone NSAID Naproxen lysozyme conjugate NSAID Acetal salicylic acid Immunosuppresive and antiviral Leflunomide Quinolones Hydroxychloroquine (Plaquenil) Uricosurics Sulfinpyrazone MSC Matrix Collagen (e.g., collagen type I, III, V, VI, VII and XV) MSC Matrix Fibrin MSC Matrix Polylactatous Extracellular Matrix Targeting Glycosaminoglycans (both sulphated and non- sulphated glycosaminoglycans), glycoproteins and polysaccharides Surfactant P188 and other surfactants Vascular Growth Factor Angiopoetin Molecules for Bone Marrow Niches Bone morphogenitic proteins Catecholamines Epinephrine Catecholamines Norepinephrine Molecules for Bone Marrow Niches Jagged1 Notch Ligand osteopontin Hormone parathyoid hormone Hormone Calcitonin Molecules for Bone Marrow Niches steel factor Glycoprotein Hormone thrombopoetin Vascular Growth Factor vascular cell adhesion molecule 1 Chemokine Molecules for Bone CXCL12 Marrow Niches B Cell Targeting Agents Rituximab B Cell Targeting Agents BLys B Cell Targeting Agents TACI JAK Targeting Agents Tofacitinib Calcineurin Inhibitors Voclosporin COX-2 Inhibitors Iguratimod COX-2 Inhibitors Montelukast COX-2 Inhibitors Rofecoxib COX-2 Inhibitors Valdecoxib Interferon Receptor Inhibitors Anifrolumab IFN-α Inhibitors Sifalimumab Anti-IgE Agents Omalizumab iNOS Inhibitors S-methylisothiourea CD20 Antagonists/B Cell Inhibitors Ocrelizumab BAFF Antagonists/B Cell Inhibitors Belimumab TNF Superfamily BAFF and APRIL Atacicept Antagonists/B cell Inhibitors TNF-α Antagonists Thalidomide TNF-α Antagonists Lenalidomide TNF-α Antagonists Pomalidomide TNF-α Antagonists Pentocifylline TNF-α Antagonists Bupropion TNF Antagonists Lentiviral-mediated RNAi TNF Agonists Recombinant TNF-α TRAIL Receptor Agonists HGS-ETR1 TRAIL Receptor Agonists HGS-ETR2 TRAIL Receptor Agonists HGS-TR2J TRAIL Receptor Agonists PRO1762 TRAIL Receptor Agonists TRA-8 CD95/Fas Agonists CD95-Fc Marine Bioactive Compounds TRAIL-Resistance Overcoming Marine Bioactive Compounds Marine Bioactive Compounds mazamine A Marine Bioactive Compounds marine-derived chroomycins Marine Bioactive Compounds carotenoids Marine Bioactive Compounds Aplysin Marine Bioactive Compounds Aplidin Marine Bioactive Compounds Siphonaxanthin Marine Bioactive Compounds pectinotoxin-2 Anti-Complement Drugs Eculizumab PAR-2 Modulators Pepducin P2pal-18 miR-2013 Blockers Anti-sense oligonucleotides Nrf2 Activator Dimethyl fumarate p53 Targeting Drugs INGN201 p53 Targeting Drugs SCH58500 p53 Targeting Drugs ONYX-015 p53 Targeting Drugs C-terminal p53 peptides p53 Targeting Drugs CDB3 p53 Targeting Drugs CP31398 p53 Targeting Drugs Prima-1 p53 Targeting Drugs HPV E6-binding peptide aptamers p53 Targeting Drugs Nutlins p53 Targeting Drugs Chalcones p53 Targeting Drugs Small peptides p53 Targeting Drugs Pifithrin-α p53 Targeting Drugs/Apoptosis QP1-1002 Modifiers (T cells) Endothelin-1 Targeting Drugs Astrasentan Immune Modulators Laquinimod Slow-acting antirheumatic drugs (SAARDs) Colcrys Hormones parathyroid hormone Hormones growth hormone 11-beta hydroxysteroid dehydrogenases mineralocorticoid proopiomelanocortin fludrocortisonesoxycorticosterone acetate vaccines from live attenuated viruses Aspirin Insulin Isonizaid Oral hypoglycemic agents Antacids carbamazepine cholestyramine colestipol ephedrine erythromyin mitotane oral contraceptives phenobarbital phenytoin rifampin troleandomycin Non-selective caspase inhibitor okadaic acid Camptothetic Staurosporine HFA Alvesco inhalation Breo Ellipta Advair Reactive Oxygen Species Targeting Drugs Cytokines/Growth Factors TGF-beta NOD-like receptor protein 3- dependent caspase 1 Targeting Drugs NSAID Etoricoxib Apoptosis Modifiers MCL1 inhibitors Teriparatide BH3 mimetics AZD 4320 Carrier Proteins Low molecular weight human serum albumin Ceramide Targeting Drugs Chondrogenic factors Anti-oxidative factors A(1)AR agonist S1P(2)R antagonist Antimalarials BAX/BAK activating drugs Selective GR Activators (SEGRAs) Rap1 Targeted Drugs Caspase-1 ICE Inhibitors VX-740 (Pralnacasan) Cathepsin K Targeting Agents Odanacatib TNF-α Antagonists CDP571 TNF-α Antagonists ISIS 104838 Anti-Pain Drugs Duloxetine Cytokines/Growth Factors TGF-beta Immunosuppressants Rapamycin HIF-1α Modulators HIF-2α Modulators Angiotensin receptor blockers Angiotensin receptor blocker losartan (Cozaar) Hormones Adrenocorticotropic hormone Hormones corticotropin-releasing hormone digitalis glycosides potassium-depleting diuretics Coumarine anticoagulants NLRP3 Inflammosome Targeted MCC950 Drugs NLRP3 Inflammosome Targeted BHB Drugs NLRP3 Inflammosome Targeted Type I interferon Drugs NLRP3 Inflammosome Targeted IFN-beta Drugs NLRP3 Inflammosome Targeted resveratrol Drugs NLRP3 Inflammosome Targeted arglabin Drugs NLRP3 Inflammosome Targeted CB2R agonist Drugs NLRP3 Inflammosome Targeted MicroRNA-223 Drugs Immunosuppresive and rapamycin antiproliferative Bcl-2/Bcl-xL antagonist ABT-737 Tyrosine kinase inhibitor dasatinib Oxycodone Janus kinase inhibitor Tofacitinib (generic name of Xeljanz)

TABLE 6 Further Active Agents for Treatment of Kidney Disorders Active Agent Class Active Agent Biguanide metformin Immunosuppressive mTOR modulators Immunosuppressive and FOXO4 peptide antiproliferative Anti-inflammatory, Triptolide immunosuppressive Antioxidant Alpha-lipoic acid Checkpoint inhibitors Nivolumab Checkpoint inhibitors Pembrolizumab Checkpoint inhibitors Pidilizumab Checkpoint inhibitors Bmx-936559 Checkpoint inhibitors Atezolizumab Checkpoint inhibitors Avelumab Antibiotics Penicillins Penicillins Amoxicillin Antibiotics Cephalosporins Cephalosporins Cephalexin Antibiotics Macrolides Macrolides Azithromycin Antibiotics Fluoroquinolones Fluoroquinolones Ciprofloxacin Antibiotics Sulfonamides Sulfonamides Co-trimoxazole Antibiotics Tetracyclines Tetracyclines Doxycycline Antibiotics Aminoglycosides Diuretics Loop Diuretics Diuretics Potassium Sparing Diuretics Diuretics Chlorothiazide Diuretics Chlorthalidone Diuretics Metolazone Diuretics Indapamide Mineralocorticoid Renin Inhibitors Renin Inhibitors aliskiren Renin Inhibitors pepstatin Renin Inhibitors statine Renin Inhibitors cgp2928 Renin Inhibitors remikiren Renin Inhibitors enalkiren Renin Inhibitors zankiren SGLT modulator Dapagliflozin SGLT modulator Canagliflozin SGLT modulator Empagliflozin Acetylsalicylic acid Steroid Beclomethasone monopropionate IL-17 inhibitor Caspaicin Deferasirox Olmesartan L-glutamic acid polymer Tirilazad Dietary flavonols siRNA Rapamycin analogs RAD001 Counter-irritants Piperine Counter-irritants Mustard Oil Counter-irritants Eugenol Counter-irritants Curcumin Counter-irritant capsaicin-like Resiniferatoxin (RTX) molecule

Further examples of active agents include but are not limited to: a peptide, an oligopeptide, a polypeptide, a peptidomimetic, a polynucleotide, a polyribonucleotide, a DNA, a cDNA, a ssDNA, a RNA, a dsRNA, a micro RNA, an RNAi, an oligonucleotide, an antibody, a single chain variable fragment (scFv or a single chain Fv), an antibody fragment, an aptamer, a cytokine, an interferon, a hormone, an enzyme, a growth factor, alpha-lipoic acid (to prevent nephrotoxicity to tubular cells after chemotherapy (e.g. cisplatin) or administration of an NSAID (e.g. indomethacin), a checkpoint inhibitor, nivolumab, pembrolizumab, pidilizumab, bmx-936559, atezolizumab, avelumab, a PD-1 inhibitor, a PD-L1 inhibitor, a CTLA4 inhibitor, a CD antigen, aa chemokine, a neurotransmitter, an ion channel inhibitor, a G-protein coupled receptor inhibitor, a G-protein coupled receptor activator, a chemical agent, a radiosensitizer, a radioprotectant, a radionuclide, a therapeutic small molecule, a steroid, a corticosteroid, an anti-inflammatory agent, an immune modulator, a complement fixing peptide or protein, a tumor necrosis factor inhibitor, a tumor necrosis factor activator, a tumor necrosis factor receptor family agonist, a tumor necrosis receptor antagonist, a tumor necrosis factor (TNF) soluble receptor or antibody, caspase protease activator or inhibitor, an NF-κB a RIPK1 and/or RIPK3 inhibitor or activator (e.g., through Toll-like receptors (TLRs) TLR-3 and/or TLR-4, or T-cell receptor (TCR) and the like), a death-receptor ligand (e.g., Fas ligand) activator or inhibitor, TNF receptor family (e.g., TNFR1, TNFR2, lymphotoxin β receptor/TNFRS3, OX40/TNFRSF4, CD40/TNFRSF5, Fas/TNFRSF6, decoy receptor 3/TNFRSF6B, CD27/TNFRSF7, CD30/TNFRSF8, 4-1BB/TNFRSF9, DR4 (death receptor 4/TNFRS10A), DR5 (death receptor 5/TNFRSF10B), decoy receptor 1/TNFRSF10C, decoy receptor 2/TNFRSF10D, RANK (receptor activator of NF-kappa B/TNFRSF11A), OPG (osteoprotegerin/TNFRSF11B), DR3 (death receptor 3/TNFRSF25), TWEAK receptor/TNFRSF12A, TAC1/TNFRSF13B, BAFF-R (BAFF receptor/TNFRSF13C), HVEM (herpes virus entry mediator/TNFRSF14), nerve growth factor receptor/TNFRSF16, BCMA (B cell maturation antigen/TNFRSF17), GITR (glucocorticoid-induced TNF receptor/TNFRSF18), TAJ (toxicity and JNK inducer/TNFRSF19), RELT/TNFRSF19L, DR6 (death receptor 6/TNFRSF21), TNFRSF22, TNFRSF23, ectodysplasin A2 isoform receptor/TNFRS27, ectodysplasin 1, and anhidrotic receptor, a TNF receptor superfamily ligand including—TNF alpha, lymphotoxin-α, tumor necrosis factor membrane form, tumor necrosis factor shed form, LIGHT, lymphotoxin β₂α₁ heterotrimer, OX-40 ligand, compound 1 [PMID: 24930776], CD40 ligand, Fas ligand, TL1A, CD70, CD30 ligand, TRAF1, TRAF2, TRAF3, TRAIL, RANK ligand, APRIL, BAFF, B and T lymphocyte attenuator, NGF, BDNF, neurotrophin-3, neurotrophin-4, TL6, ectodysplasin A2, ectodysplasin A1—a TIMP-3 inhibitor, a BCL-2 family inhibitor, navitoclax (Aging Cell. 15(3): 428-435. (2016)), an IAP disruptor, a protease inhibitor, an amino sugar, a chemotherapeutic (whether acting through an apoptotic or non-apoptotic pathway) (Ricci et al. Oncologist 11(4):342-57 (2006)), a cytotoxic chemical, a toxin, a tyrosine kinase inhibitor (e.g. imatinib mesylate), protons, bevacuzimab (antivascular agent), erlotinib (EGFR inhibitor), QPI-1002, QM56, SVT016426 (QM31), 16/86 (third generation ferrostatin), BASP siRNA, CCX140, BIIB023, CXA-10, alkaline phosphatase, Dnmt1 inhibitor, THR-184, lithium, formoterol, IL-22, EPO and EPO derivatives, agents that stimulate erthyropoietin such as epoeitn alfa or darbepoietin alfa, PDGF inhibitors, CRMD-001, Atrasentan, Tolvaptan, RWJ-676070, Abatacept, Sotatercept, the binding site of the extracellular domain of the activing receptor 2A, an anti-infective agent, an antibiotic; such as gentamicin, vancomycin, minocin or mitomyclin, penicillins (such as amoxicillin), cephalosporins (such as cephalexin), macrolides (such as azithromycin), fluoroquinolones (such as ciprofloxacin), sulfonamides (such as co-trimoxazole), tetracyclines (such as doxycycline), aminoglycosides, an anti-infective agent, an antibiotic, an anti-viral agent, an anti-fungal agent, an aminoglycoside, a nonsteroidal anti-inflammatory drug (NSAID), a statin, a nanoparticle, a liposome, such as ketorolac or ibuprofen, an immunosuppresant such tacrolimus, mycophenolic acid (e.g., mycophenolate mofetil), cyclosporine A, or azathioprine, a diuretic drug including thiazides, loop diuretics, and potassium sparing diuretics, bumetanide, ethacrynic acid, furosemide, torsemide, glucose, mannitol, amiloride, spironolactone, eplerenone, triamterene, potassium canrenoate, bendroflumethiazide, chlorothiazide, chlorthalidone, metolazone, indapamide, hydrochlorothiazide, vasopressin, amphotericin B, acetazolamide, tovaptan, conivaptan, dopamine, dorzolamide, bendrolumethiazide, hydrochlorothiazide, caffeine, theophylline, or theobromine, a statin, a senolytic such as navitoclax or obatoclax, a corticosteroid such as prednisone, betamethasone, fludrocortisone, deoxycorticosterone, aldosterone, cortisone, hydrocortisone, belcometasone, dexamethasone, mometasone, fluticasone, prednisolone, methylprednisolone, triamcinolone acetonide or triamcinolone, a glucocorticoid, a mineralocorticoid, such as aldosterone and flucrocortisone, a liposome, renin, renin inhibitors such as aliskiren, pepstatin, statine, cgp2928, remikiren, enalkiren, zankiren, angiotensin, ACE inhibitors such as ramipril, captopril, lisinopril, benazepril, quinapril, fosinopril, trandolapril, moexipril, enalaprilat, enalapril maleate, or perindopril erbumine, mediator of apoptosis, mediator of fibrosis, drug that targets p53, Apaf-1 inhibitor, RIPK1 inhibitor, RIPK3 inhibitor, inhibitor of IL17, inhibitor of IL6, inhibitor of IL23, inhibitor of CCR2, nitrated fatty acids, angiotensin blockers, agonists of the ALK3 receptor, retinoic acid, SGLT2 modulator, such as Dapagliflozin, canagliflozin, and empagliflozin, a polymer, a biopolymer, a polysaccharide, a proteoglycan, a glycosaminoglycan, polyethylene glycol, a lipid, a dendrimer, a fatty acid, or an Fc domain or an Fc region, or an active fragment or a modification thereof. Any combination of the above active agents can be co-delivered with peptides or peptide conjugates of this disclosure. Additionally, in some embodiments, other co-therapies such as proton therapy or ablative radiotherapy can be administered to a subject in need thereof along with peptides or peptide conjugates of this disclosure. In some embodiments, the peptide is covalently or non-covalently linked to an active agent, e.g., directly or via a linker. TNF blockers suppress the immune system by blocking the activity of TNF, a substance in the body that can cause inflammation and lead to immune-system diseases, such as lupus, Crohn's disease, and ulcerative colitis. The drugs in this class include Remicade (infliximab), Enbrel (etanercept), Humira (adalimumab), Cimzia (certolizumab pegol) and Simponi (golimumab). The peptide disclosed herein can be used to home, distribute to, target, directed to, is retained by, accumulate in, migrate to, and/or bind to kidneys, and thus also be used for localizing the attached or fused active agent. Furthermore, chlorotoxin peptide can be internalized in cells (Wiranowska, M., Cancer Cell Int., 11: 27 (2011)). Therefore, cellular internalization, subcellular localization, and intracellular trafficking after internalization of the peptide itself, or an active agent peptide conjugate or fusion peptide can be important factors in the efficacy of an active agent conjugate or fusion. (Ducry, L., Antibody Drug Conjugates (2013); and Singh, S. K., Pharm Res. 32(11): 3541-3571 (2015)). Exemplary linkers suitable for use with the embodiments herein are discussed in further detail below.

The peptides or peptide-active agent fusions of the present disclosure can also be conjugated to other moieties that can serve other roles, such as providing an affinity handle (e.g., biotin) for retrieval of the peptides from tissues or fluids. For example, peptides or peptide-active agent fusions of the present disclosure can also be conjugated to biotin. In addition to extension of half-life, biotin could also act as an affinity handle for retrieval of peptides or peptide-active agent fusions from tissues or other locations. In some embodiments, fluorescent biotin conjugates that can act both as a detectable label and an affinity handle can be used. Non limiting examples of commercially available fluorescent biotin conjugates include Atto 425-Biotin, Atto 488-Biotin, Atto 520-Biotin, Atto-550 Biotin, Atto 565-Biotin, Atto 590-Biotin, Atto 610-Biotin, Atto 620-Biotin, Atto 655-Biotin, Atto 680-Biotin, Atto 700-Biotin, Atto 725-Biotin, Atto 740-Biotin, fluorescein biotin, biotin-4-fluorescein, biotin-(5-fluorescein) conjugate, and biotin-B-phycoerythrin, Alexa fluor 488 biocytin, Alexa flour 546, Alexa Fluor 549, lucifer yellow cadaverine biotin-X, Lucifer yellow biocytin, Oregon green 488 biocytin, biotin-rhodamine and tetramethylrhodamine biocytin. In some other examples, the conjugates could include chemiluminescent compounds, colloidal metals, luminescent compounds, enzymes, radioisotopes, and paramagnetic labels. In some embodiments, the peptide-active agent fusions described herein can be attached to another molecule. For example, the peptide sequence also can be attached to another active agent (e.g., small molecule, peptide, polypeptide, polynucleotide, antibody, aptamer, cytokine, growth factor, neurotransmitter, an active fragment or modification of any of the preceding, fluorophore, radioisotope, radionuclide chelator, acyl adduct, chemical linker, or sugar, etc.). In some embodiments, the peptide can be fused with, or covalently or non-covalently linked to an active agent.

Additionally, more than one peptide sequence can be present on or fused with a particular peptide. A peptide can be incorporated into a biomolecule by various techniques, for example by a chemical transformation, such as the formation of a covalent bond, such as an amide bond, or by solid phase or solution phase peptide synthesis, or by preparing a nucleic acid sequence encoding the biomolecule, wherein the nucleic acid sequence includes a subsequence that encodes the peptide. The subsequence can be in addition to the sequence that encodes the biomolecule, or can substitute for a subsequence of the sequence that encodes the biomolecule.

In some embodiments, the peptides of the present disclosure are coupled (e.g., conjugated) to other moieties that, e.g., can modify or effect changes to the properties of the peptides. For example, in certain embodiments, the peptides described herein are attached to another molecule, such as an active agent that provides a functional capability. Examples of active agents include but are not limited to: a peptide, an oligopeptide, a polypeptide, a polynucleotide, a polyribonucleotide, a DNA, a cDNA, a ssDNA, a RNA, a dsRNA, a micro RNA, an oligonucleotide, an antibody fragment, a single chain Fv, an aptamer, a cytokine, an enzyme, a growth factor, a chemokine, a neurotransmitter, a chemical agent, a fluorophore, a metal, a metal chelate, an X-ray contrast agent, a PET agent, a radioisotope, a photosensitizer, a radiosensitizer, a radionuclide chelator, a therapeutic small molecule, a steroid, a corticosteroid, an anti-inflammatory agent, an immune modulator, a protease inhibitor, an amino sugar, a chemotherapeutic, a cytotoxic chemical, a toxin, a tyrosine kinase inhibitor, an anti-infective agent, an antibiotic, an anti-viral agent, an anti-fungal agent, an aminoglycoside, a nonsteroidal anti-inflammatory drug (NSAID) such as ketorolac or ibuprofen, a statin, a nanoparticle, a liposome, a polymer, a biopolymer, a polysaccharide, a proteoglycan, a glycosaminoglycan, a dendrimer, a fatty acid, or an Fc region, or an active fragment or a modification thereof. In some embodiments, the peptide is covalently or non-covalently linked to an active agent, e.g., directly or via a linker. Exemplary linkers suitable for use with the embodiments herein are discussed in further detail below.

In some embodiments, the active agent interacts with a renal ion channel, inhibits a protease, has antimicrobial activity, has anticancer activity, has anti-inflammatory activity, induces ischemic preconditioning or acquired cytoresistance, produces a protective or therapeutic effect on a kidney of the subject, reduces a clearance rate of the composition, or a combination thereof. Optionally, the active agent is a renal therapeutic agent, such as a renal protective agent or renal prophylactic agent that induces ischemic preconditioning and/or acquired cytoresistance in a kidney of a subject. Additional details regarding renal therapeutic agents are provided below.

In some embodiments, the peptides of the present disclosure can be modified such that the modification increases the stability and/or the half-life of the peptides. In some embodiments, the attachment of a hydrophobic moiety, such as to the N-terminus, the C-terminus, or on an internal amino acid, can be used to extend half-life of a peptide of the present disclosure. In some embodiments, simple carbon chains (e.g., by myristoylation and/or palmitylation) can be conjugated to the fusion proteins or peptides. In some embodiments, the simple carbon chains can render the peptides easily separable from the unconjugated material. For example, methods that can be used to separate the peptides from the unconjugated material include, but are not limited to, solvent extraction and reverse phase chromatography. The lipophilic moieties can extend half-life through reversible binding to serum albumin. The conjugated moieties can, e.g., be lipophilic moieties that extend half-life of the peptides through reversible binding to serum albumin. In some embodiments, simple carbon chains (e.g., by myristoylation) can be conjugated to the peptides. In some embodiments, the lipophilic moiety can be cholesterol or a cholesterol derivative including cholestenes, cholestanes, cholestadienes and oxysterols. In some embodiments, the peptides can be conjugated to myristic acid (tetradecanoic acid) or a derivative thereof.

Detectable Agent Conjugates

Described herein are agents that can be conjugated to the peptides of the present invention for use in detection and tracing either kidney disorders, or both. As described herein, it is understood that certain active agents are described in a non-limiting exemplary manner for use in diagnostics, aiding surgery and treatment, prognosis and tracking of progress or remission of kidney disorders, diseases or injury. One or more of such detectable agents can be conjugated to a peptide of the present invention alone or in combination with one or more active agents described herein. Moreover some detectable agents (e.g., radionuclides, radioisotopes, radiosensitizers and photosensitizers amongst others) may also exert therapeutic activity as well. A peptide can be conjugated to an agent used in imaging, research, therapeutics, theranostics, pharmaceuticals, chemotherapy, chelation therapy, targeted drug delivery, and radiotherapy. The agent can be a detectable agent. In some embodiments, a peptide of the present invention is conjugated to detectable agents, such as a metal, a radioisotope, a dye, fluorophore, or another suitable material that can be used in imaging. Non-limiting examples of radioisotopes include alpha emitters, beta emitters, positron emitters, and gamma emitters. In some embodiments, the metal or radioisotope is selected from the group consisting of actinium, americium, bismuth, cadmium, cesium, cobalt, europium, gadolinium, iridium, lead, lutetium, manganese, palladium, polonium, radium, ruthenium, samarium, strontium, technetium, thallium, and yttrium. In some embodiments, the metal is actinium, bismuth, lead, radium, strontium, samarium, or yttrium. In some embodiments, the radioisotope is actinium-225 or lead-212. In some embodiments, the fluorophore is a fluorescent agent emitting electromagnetic radiation at a wavelength between 650 nm and 4000 nm, such emissions being used to detect such agent. In some embodiments the fluorophore is a fluorescent agent is selected from the group consisting of non-limiting examples of fluorescent dyes that could be used as a conjugating molecule (or as applied to each class of molecules) in the present disclosure include DyLight-680, DyLight-750, VivoTag-750, DyLight-800, IRDye-800, VivoTag-680, Cy5.5, ZQ800, or indocyanine green (ICG class of dyes). In some embodiments, near infrared dyes often include cyanine dyes. Additional non-limiting examples of fluorescent dyes for use as a conjugating molecule in the present disclosure include acradine orange or yellow, Alexa Fluors and any derivative thereof, 7-actinomycin D, 8-anilinonaphthalene-1-sulfonic acid, ATTO dye and any derivative thereof, auramine-rhodamine stain and any derivative thereof, bensantrhone, bimane, 9-10-bis(phenylethynyl)anthracene, 5,12-bis(phenylethynyl)naththacene, bisbenzimide, brainbow, calcein, carbodyfluorescein and any derivative thereof, 1-chloro-9,10-bis(phenylethynyl)anthracene and any derivative thereof, DAPI, DiOC6, DyLight Fluors and any derivative thereof, epicocconone, ethidium bromide, FlAsH-EDT2, Fluo dye and any derivative thereof, FluoProbe and any derivative thereof, Fluorescein and any derivative thereof, Fura and any derivative thereof, GelGreen and any derivative thereof, GelRed and any derivative thereof, fluorescent proteins and any derivative thereof, m isoform proteins and any derivative thereof such as for example mCherry, hetamethine dye and any derivative thereof, hoeschst stain, iminocoumarin, indian yellow, indo-1 and any derivative thereof, laurdan, lucifer yellow and any derivative thereof, luciferin and any derivative thereof, luciferase and any derivative thereof, mercocyanine and any derivative thereof, nile dyes and any derivative thereof, perylene, phloxine, phyco dye and any derivative thereof, propium iodide, pyranine, rhodamine and any derivative thereof, ribogreen, RoGFP, rubrene, stilbene and any derivative thereof, sulforhodamine and any derivative thereof, SYBR and any derivative thereof, synapto-pHluorin, tetraphenyl butadiene, tetrasodium tris, Texas Red, Titan Yellow, TSQ, umbelliferone, violanthrone, yellow fluorescent protein and YOYO-1. Other Suitable fluorescent dyes include, but are not limited to, fluorescein and fluorescein dyes (e.g., fluorescein isothiocyanine or FITC, naphthofluorescein, 4′,5′-dichloro-2′,7′-dimethoxyfluorescein, 6-carboxyfluorescein or FAM, etc.), carbocyanine, merocyanine, styryl dyes, oxonol dyes, phycoerythrin, erythrosin, eosin, rhodamine dyes (e.g., carboxytetramethyl-rhodamine or TAMRA, carboxyrhodamine 6G, carboxy-X-rhodamine (ROX), lissamine rhodamine B, rhodamine 6G, rhodamine Green, rhodamine Red, tetramethylrhodamine (TMR), etc.), coumarin and coumarin dyes (e.g., methoxycoumarin, dialkylaminocoumarin, hydroxycoumarin, aminomethylcoumarin (AMCA), etc.), Oregon Green Dyes (e.g., Oregon Green 488, Oregon Green 500, Oregon Green 514., etc.), Texas Red, Texas Red-X, SPECTRUM RED, SPECTRUM GREEN, cyanine dyes (e.g., CY-3, Cy-5, CY-3.5, CY-5.5, etc.), ALEXA FLUOR dyes (e.g., ALEXA FLUOR 350, ALEXA FLUOR 488, ALEXA FLUOR 532, ALEXA FLUOR 546, ALEXA FLUOR 568, ALEXA FLUOR 594, ALEXA FLUOR 633, ALEXA FLUOR 660, ALEXA FLUOR 680, etc.), BODIPY dyes (e.g., BODIPY FL, BODIPY R6G, BODIPY TMR, BODIPY TR, BODIPY 530/550, BODIPY 558/568, BODIPY 564/570, BODIPY 576/589, BODIPY 581/591, BODIPY 630/650, BODIPY 650/665, etc.), IRDyes (e.g., IRD40, IRD 700, IRD 800, etc.), indocyanine green dyes and the like. For each of the above listed fluorescent dyes various activated forms can be used for conjugation and the like. Additional suitable detectable agents are described in PCT/US14/56177. Non-limiting examples of radioisotopes include alpha emitters, beta emitters, positron emitters, and gamma emitters. In some embodiments, the metal or radioisotope is selected from the group consisting of actinium, americium, bismuth, cadmium, cesium, cobalt, europium, gadolinium, iridium, lead, lutetium, manganese, palladium, polonium, radium, ruthenium, samarium, strontium, technetium, thallium, and yttrium. In some embodiments, the metal is actinium, bismuth, lead, radium, strontium, samarium, or yttrium. In some embodiments, the radioisotope is actinium-225 or lead-212.

Other embodiments of the present disclosure provide peptides conjugated to a radiosensitizer or photosensitizer. Examples of radiosensitizers include but are not limited to: ABT-263, ABT-199, WEHI-539, paclitaxel, carboplatin, cisplatin, oxaliplatin, gemcitabine, etanidazole, misonidazole, tirapazamine, and nucleic acid base derivatives (e.g., halogenated purines or pyrimidines, such as 5-fluorodeoxyuridine). Examples of photosensitizers include but are not limited to: fluorescent molecules or beads that generate heat when illuminated, porphyrins and porphyrin derivatives (e.g., chlorins, bacteriochlorins, isobacteriochlorins, phthalocyanines, and naphthalocyanines), metalloporphyrins, metallophthalocyanines, angelicins, chalcogenapyrrillium dyes, chlorophylls, coumarins, flavins and related compounds such as alloxazine and riboflavin, fullerenes, pheophorbides, pyropheophorbides, cyanines (e.g., merocyanine 540), pheophytins, sapphyrins, texaphyrins, purpurins, porphycenes, phenothiaziniums, methylene blue derivatives, naphthalimides, nile blue derivatives, quinones, perylenequinones (e.g., hypericins, hypocrellins, and cercosporins), psoralens, quinones, retinoids, rhodamines, thiophenes, verdins, xanthene dyes (e.g., eosins, erythrosins, rose bengals), dimeric and oligomeric forms of porphyrins, and prodrugs such as 5-aminolevulinic acid. Advantageously, this approach allows for highly specific targeting of diseased cells (e.g., cancer cells) using both a therapeutic agent (e.g., drug) and electromagnetic energy (e.g., radiation or light) concurrently. In some embodiments, the peptide is covalently or non-covalently linked to the agent, e.g., directly or via a linker. Exemplary linkers suitable for use with the embodiments herein are discussed in further detail below.

Linkers

Peptides according to the present disclosure that home, target, migrate to, are retained by, accumulate in, and/or bind to, or are directed to the kidney can be attached to another moiety (e.g., an active agent), such as a small molecule, a second peptide, a protein, an antibody, an antibody fragment, an aptamer, polypeptide, polynucleotide, a fluorophore, a radioisotope, a radionuclide chelator, a polymer, a biopolymer, a fatty acid, an acyl adduct, a chemical linker, or sugar or other active agent described herein through a linker, or directly in the absence of a linker.

A peptide can be directly attached to another molecule by a covalent attachment. For example, the peptide is attached to a terminus of the amino acid sequence of a larger polypeptide or peptide molecule, or is attached to a side chain, such as the side chain of a lysine, serine, threonine, cysteine, tyrosine, aspartic acid, a non-natural amino acid residue, or glutamic acid residue. The attachment can be via an amide bond, an ester bond, an ether bond, a carbamate bond, a carbon-nitrogen bond, a triazole, a macrocycle, an oxime bond, a hydrazone bond, a carbon-carbon single double or triple bond, a disulfide bond, or a thioether bond. In some embodiments, similar regions of the disclosed peptide(s) itself (such as a terminus of the amino acid sequence, an amino acid side chain, such as the side chain of a lysine, serine, threonine, cysteine, tyrosine, aspartic acid, a non-natural amino acid residue, or glutamic acid residue, via an amide bond, an ester bond, an ether bond, a carbamate bond, a carbon-nitrogen bond, a triazole, a macrocycle, an oxime bond, a hydrazone bond, a carbon-carbon single double or triple bond, a disulfide bond, or a thioether bond, or linker as described herein) can be used to link other molecules.

Attachment via a linker can involve incorporation of a linker moiety between the other molecule and the peptide. The peptide and the other molecule can both be covalently attached to the linker. The linker can be cleavable, labile, non-cleavable, stable, self-immolating, hydrophilic, or hydrophobic. As used herein, the term “non-cleavable” (such as used in association with an amide, cyclic, or carbamate linker or as otherwise as described herein) is often used by a skilled artisan to distinguish a relatively stable structure from one that is more labile or “cleavable” (e.g., as used in association with cleavable linkers that may be dissociated or cleaved structurally by enzymes, proteases, self-immolation, pH, reduction, hydrolysis, certain physiologic conditions, or as otherwise described herein). It is understood that “non-cleavable” linkers offer stability against cleavage or other dissociation as compared to “cleavable” linkers, and the term is not intended to be considered an absolute non-cleavable or non-dissociative structure under any conditions. Consequently, as used herein, a “non-cleavable” linker is also referred to as a “stable” linker. The linker can have at least two functional groups with one bonded to the peptide, the other bonded to the other molecule, and a linking portion between the two functional groups.

Non-limiting examples of the functional groups for attachment can include functional groups capable of forming an amide bond, an ester bond, an ether bond, a carbonate bond, a carbamate bond, or a thioether bond. Non-limiting examples of functional groups capable of forming such bonds can include amino groups; carboxyl groups; hydroxyl groups; aldehyde groups; azide groups; alkyne and alkene groups; ketones; hydrazides; acid halides such as acid fluorides, chlorides, bromides, and iodides; acid anhydrides, including symmetrical, mixed, and cyclic anhydrides; carbonates; carbonyl functionalities bonded to leaving groups such as cyano, succinimidyl, and N-hydroxysuccinimidyl; hydroxyl groups; sulfhydryl groups; and molecules possessing, for example, alkyl, alkenyl, alkynyl, allylic, or benzylic leaving groups, such as halides, mesylates, tosylates, triflates, epoxides, phosphate esters, sulfate esters, and besylates.

Non-limiting examples of the linking portion can include alkylene, alkenylene, alkynylene, polyether, such as polyethylene glycol (PEG), hydroxy carboxylic acids, oligoethylene glycol, polyester, polyamide, polyamino acids, polypeptides, cleavable peptides, valine-citrulline, aminobenzylcarbamates, D-amino acids, and polyamine, any of which being unsubstituted or substituted with any number of substituents, such as halogens, hydroxyl groups, sulfhydryl groups, amino groups, nitro groups, nitroso groups, cyano groups, azido groups, sulfoxide groups, sulfone groups, sulfonamide groups, carboxyl groups, carboxaldehyde groups, imine groups, alkyl groups, halo-alkyl groups, alkenyl groups, halo-alkenyl groups, alkynyl groups, halo-alkynyl groups, alkoxy groups, aryl groups, aryloxy groups, aralkyl groups, arylalkoxy groups, heterocyclyl groups, acyl groups, acyloxy groups, carbamate groups, amide groups, urethane groups, epoxides, and ester groups.

A peptide and drug conjugated via a linker is described with the formula Peptide-A-B-C-Drug, wherein the linker is A-B-C. A can be stable amide link is an amine on the peptide and the linker and can be achieved via a tetrafluorophenyl (TFP) ester or an NHS ester. B can be (—CH2—)_(x)— or a short PEG (—CH₂CH₂O—)_(x) (x is 1-10), and C can be the ester bond to the hydroxyl or carboxylic acid on the drug. In some embodiments, C can refer to the “cleavable” or “stable” part of the linker. In other embodiments, A can also be the “cleavable” part. In some embodiments, A can be amide, carbamate, thioether via maleimide or bromoacetamide, triazole, oxime, or oxacarboline. The cleaved active agent or drug can retain the chemical structure of the active agent before cleavage, or can be modified as a result of cleavage. Moreover, depending on the desired therapeutic properties of the peptide-drug conjugate, such active agent can be active while linked to the peptide, remain active after cleavage or become inactivated, be inactive while linked to the peptide, or it can be activated upon cleavage.

In some embodiments, peptide conjugates have stable linkers. A peptide of the disclosure can be expressed recombinantly or chemically synthesized. The peptide can be conjugated to a detectable agent or an active agent via a stable linker, such as an amide linkage or a carbamate linkage. The peptide can be conjugated to a detectable agent or an active agent via a stable linker, such as an amide bond using standard 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC) or dicylcohexylcarbodiimide (DCC) based chemistry or thionyl chloride or phosphorous chloride-based bioconjugation chemistries. A stable linker may or may not be cleaved in buffer over extended periods of time (e.g., hours, days, or weeks). A stable linker may or may not be cleaved in body fluids such as plasma or synovial fluid over extended periods of time (e.g., hours, days, or weeks). A stable linker, may or may not be cleaved after exposure to enzymes, reactive oxygen species, other chemicals or enzymes that can be present in cells (e.g., macrophages), cellular compartments (e.g., endosomes and lysosomes), inflamed areas of the body (e.g., inflamed joints), tissues, or body compartments. A stable linker may be cleaved by unknown mechanisms. A stable linker may or may not be cleaved in vivo, but may remain an active agent after peptide conjugation.

A peptide and drug conjugated via a linker can be described with the formula Peptide-A-B-C-Drug, wherein the linker is A-B-C. A can be a stable amide link such as that formed by reacting an amine on the peptide with a linker containing a tetrafluorophenyl (TFP) ester or an NHS ester. A can also be a stable carbamate linker such as that formed by reacting an amine on the peptide with an imidazole carbamate active intermediate formed by reaction of CDI with a hydroxyl on the linker. A can also be a stable secondary amine linkage such as that formed by reductive alkylation of the amine on the peptide with an aldehyde or ketone group on the linker. A can also be a stable thioether linker formed using a maleimide or bromoacetamide in the linker with a thiol in the peptide, a triazole linker, a stable oxime linker, or a oxacarboline linker. B can be (—CH2—)_(x)— or a short PEG (—CH₂CH₂O—)_(x) (x is 0-20) or other spacers or no spacer. C can be an amide bond formed with an amine or a carboxylic acid on the drug, a thioether formed between a maleimide on the linker and a sulfhydroyl on the drug, a secondary or tertiary amine, a carbamate, or other stable bonds. Any linker chemistry described in “Current ADC Linker Chemistry,” Jain et al., Pharm Res, 2015 DOI 10. 1007/s11095-015-1657-7 can be used.

The resulting peptide conjugates can be administered to a human or animal subcutaneously, intravenously, orally, or injected directly into the kidney to treat disease. The peptide may not be specifically cleaved from the detectable agent or active agent via a targeted mechanism. The peptide can be degraded by mechanisms such as catabolism, releasing a drug that is modified or not modified form its native form (Antibody-Drug Conjugates: Design, Formulation, and Physicochemical Stability, Singh, Luisi, and Pak. Pharm Res (2015) 32:3541-3571). The peptide drug conjugate exerts its pharmacological activity while still intact, or while partially or fully degraded, metabolized, or catabolized.

In some embodiments, peptide conjugates can have cleavable linkers. In some embodiments, a peptide and drug can be conjugated via a linker and can be described with the formula Peptide-A-B-C-Drug, wherein the linker is A-B-C. In some embodiments, A can be a stable amide link such as that formed by reacting an amine on the peptide with a linker containing a tetrafluorophenyl (TFP) ester or an NHS ester. In certain embodiments, A can also be a stable carbamate linker such as that formed by reacting an amine on the peptide with an imidazole carbamate active intermediate formed by reaction of CDI with a hydroxyl on the linker. In other embodiments, A can also be a stable secondary amine linkage such as that formed by reductive alkylation of the amine on the peptide with an aldehyde or ketone group on the linker. In some embodiments, A can also be a stable thioether linker formed using a maleimide or bromoacetamide in the linker with a thiol in the peptide, a triazole linker, a stable oxime linker, or an oxacarboline linker. B can be (—CH2—)_(x)— or a short PEG (—CH₂CH₂O—)_(x) (x is 0-20) or other spacers or no spacer. C can be an ester bond to the hydroxyl or carboxylic acid on the drug, or a carbonate, hydrazone, or acylhydrazone, designed for hydrolytic cleavage. The hydrolytic rate of cleavage can be varied by varying the local environment around the bond, including carbon length (—CH2—)_(x), steric hindrance (including adjacent side groups such as methyl, ethyl, cyclic), hydrophilicity or hydrophobicity. In some embodiments, peptide conjugates can have a linear or cyclic ester linkage, which can include or do not include side chains such as methyl or ethyl groups. A linear ester linkage can be more susceptible to cleavage (such as by hydrolysis, an enzyme such as esterase, or other chemical reaction) than a cyclic ester due to steric hindrance or hydrophobicity/hydrophilicity effects. Likewise, side chains such as methyl or ethyl groups on the linear ester linkage can optionally make the linkage less susceptible to cleavage than without the side chains. In some embodiments, hydrolysis rate can be affected by local pH, such as lower pH in certain compartments of the body or of the cell such as endosomes and lysosomes or diseased tissues. In some embodiments, C can also be a pH sensitive group such as a hydrazone or oxime linkage. In other embodiments, C can be a disulfide bond designed to be released by reduction, such as by glutathione. In other embodiments, (or A-B-C) can be a peptidic linkage design for cleavabe by enzymes. Optionally, a self-immolating group such as pABC can be included to cause release of a free unmodified drug upon cleavage (Antibody-Drug Conjugates: Design, Formulation, and Physicochemical Stability, Singh, Luisi, and Pak. Pharm Res (2015) 32:3541-3571). The linker can be cleaved by enzymes such as esterases, matrix metalloproteinases, cathepsins such as cathepsin B, glucuronidases, a protease, or thrombin. Alternatively, the bond designed for cleavage can be at A, rather than C, and C can be a stable bond or a cleavable bond. An alternative design can be to have stable linkers (such as amide or carbamate) at A and C and have a cleavable linker in B, such as a disulfide bond. The rate of reduction can be modulated by local effects such as steric hindrance from methyl or ethyl groups or modulating hydrophobicity/hydrophilicity. In some embodiments, peptide conjugates can have an ester carbonyl linkage, a long hydrocarbon linker, or carbamate linker, each of which can include hydrophilic groups, such as alcohols, acids, or ethers, or can include a hydrocarbon side chain or other moiety that tunes the rate of cleavage. For example, the rate of hydrolysis can be faster with hydrophilic groups, such as alcohols, acids, or ethers, near an ester carbonyl. In another example, hydrophobic groups present as side chains or as a longer hydrocarbon linker can slow the cleavage rate of the ester. Likewise, cleavage of a carbamate group can also be tuned by hindrance, hydrophobicity, and the like. In another example, using a less labile linking group, such as a carbamate rather than an ester, can slow the cleavage rate of the linker.

Non-limiting examples of linkers include:

wherein each n is independently 0 to about 1,000; 1 to about 1,000; 0 to about 500; 1 to about 500; 0 to about 250; 1 to about 250; 0 to about 200; 1 to about 200; 0 to about 150; 1 to about 150; 0 to about 100; 1 to about 100; 0 to about 50; 1 to about 50; 0 to about 40; 1 to about 40; 0 to about 30; 1 to about 30; 0 to about 25; 1 to about 25; 0 to about 20; 1 to about 20; 0 to about 15; 1 to about 15; 0 to about 10; 1 to about 10; 0 to about 5; or 1 to about 5. In some embodiments, each n is independently 0, about 1, about 2, about 3, about 4, about 5, about 6, about 7, about 8, about 9, about 10, about 11, about 12, about 13, about 14, about 15, about 16, about 17, about 18, about 19, about 20, about 21, about 22, about 23, about 24, about 25, about 26, about 27, about 28, about 29, about 30, about 31, about 32, about 33, about 34, about 35, about 36, about 37, about 38, about 39, about 40, about 41, about 42, about 43, about 44, about 45, about 46, about 47, about 48, about 49, or about 50. In some embodiments, m is 1 to about 1,000; 1 to about 500; 1 to about 250; 1 to about 200; 1 to about 150; 1 to about 100; 1 to about 50; 1 to about 40; 1 to about 30; 1 to about 25; 1 to about 20; 1 to about 15; 1 to about 10; or 1 to about 5. In some embodiments, m is 0, about 1, about 2, about 3, about 4, about 5, about 6, about 7, about 8, about 9, about 10, about 11, about 12, about 13, about 14, about 15, about 16, about 17, about 18, about 19, about 20, about 21, about 22, about 23, about 24, about 25, about 26, about 27, about 28, about 29, about 30, about 31, about 32, about 33, about 34, about 35, about 36, about 37, about 38, about 39, about 40, about 41, about 42, about 43, about 44, about 45, about 46, about 47, about 48, about 49, or about 50.

In some cases a linker can be a succinic linker, and a drug can be attached to a peptide via an ester bond or an amide bond with two methylene carbons in between. In other cases, a linker can be any linker with both a hydroxyl group and a carboxylic acid, such as hydroxy hexanoic acid or lactic acid.

The linker can be a cleavable or a stable linker. The use of a cleavable linker permits release of the conjugated moiety (e.g., a therapeutic agent) from the peptide, e.g., after targeting to the kidney. In some cases the linker is enzyme cleavable, e.g., a valine-citrulline linker. In some embodiments, the linker contains a self-immolating portion. In other embodiments, the linker includes one or more cleavage sites for a specific protease, such as a cleavage site for matrix metalloproteases (MMPs), thrombin, or cathepsin. Alternatively or in combination, the linker is cleavable by other mechanisms, such as via pH, reduction, thiol exchange or hydrolysis. The use of a cleavable linker permits release of the conjugated moiety (e.g., a therapeutic agent) from the peptide, e.g., after targeting to the renal tissue. A hydrolytically labile linker, (amongst other cleavable linkers described herein) can be advantageous in terms of releasing active agents from the peptide. For example, an active agent in a conjugate form with the peptide may not be active, but upon release from the conjugate after targeting to the kidney, the active agent is active. Alternatively, a stable linker can still permit release of an active cleavage product after catabolism in a cell. In some embodiments, a peptide can be conjugated to an active agent by common techniques known in the art, such those described in Bioconjugate Techniques by Greg T. Hermanson (Elsevier Inc., 3^(rd) Edition, 2013)).

The rate of hydrolysis of the linker can be tuned. For example, the rate of hydrolysis of linkers with unhindered esters is faster compared to the hydrolysis of linkers with bulky groups next an ester carbonyl. As additional examples, the rate of disulfide cleavage or exchange with unhindered disulfides is faster compared to the rate of disulfide cleavage or exchange of linkers with bulky groups near disulfide bonds. Protease sites can also affect cleavage rates. A bulky group can be a methyl group, an ethyl group, a phenyl group, a ring, or an isopropyl group, or any group that provides steric bulk. In some cases, the steric bulk can be provided by the drug itself, such as by ketorolac when conjugated via its carboxylic acid. The rate of hydrolysis of the linker can be tuned according to the residency time of the conjugate in the kidney. For example, when a peptide is cleared from the kidney relatively quickly, the linker can be tuned to rapidly hydrolyze. In contrast, for example, when a peptide has a longer residence time in the kidney, a slower hydrolysis rate can allow for extended delivery of an active agent. This can be important when the peptide is used to deliver a drug to the kidney. “Programmed hydrolysis in designing paclitaxel prodrug for nanocarrier assembly” Sci Rep 2015, 5, 12023 Fu et al., provides an example of modified hydrolysis rates.

Peptide Stability

A peptide of the present disclosure can be stable in various biological conditions as well as during manufacturing, handling, storage, and other conditions in either a liquid or a dried state. Additionally, a peptide of the present disclosure can be resistant to enzymatic cleavage needed for peptide processing by the immune system. For example, any peptide of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 569 can exhibit resistance to reducing agents, proteases, oxidative conditions, or acidic conditions.

In some cases, biologic molecules (such as peptides and proteins) can provide therapeutic functions, but such therapeutic functions are decreased or impeded by instability caused by the in vivo environment. (Moroz et al. Adv Drug Deliv Rev 101:108-21 (2016), Mitragotri et al. Nat Rev Drug Discov 13(9):655-72 (2014), Bruno et al. Ther Deliv (11):1443-67 (2013), Sinha et al. Crit Rev Ther Drug Carrier Syst. 24(1):63-92 (2007), Hamman et al. BioDrugs 19(3):165-77 (2005)).

Peptide degradation can be a result of a number of processes involving hydrolytic pathways, peptide oxidation such as oxidation of methionine (Met) residues, deamidation of asparagine (Asn) and glutamine (Gln) residues, and isomerization and hydrolysis of an adjacent asparagine (Asp) residue. (Manning et al., Pharmaceutical Research, Vol. 27 No. 4 (2010)). The amino acid immediately following the Asn or Gln residue can also affect the rate of deamidation, whereas: Asn-Gly, Asn-Ser, Asn-His, and Gln-Gly can be more likely to undergo deamidation. Additionally, the peptide bond adjacent to amino acids such as Asp can undergo hydrolysis with amino acid pairings such as Asp-Gly, Asp-Ser, Asp-Tyr, and Asp-Pro, which can be more likely to undergo hydrolysis. Oxidation of amino acid residues such as Met can form a sulfoxide species. The specific degradation reactions rates can vary for any given peptide or protein sequence.

Furthermore, the microenvironment within the molecular structure of the peptide, solvent accessibility, and conformational stability of each residue can impact the likelihood of peptide degradation. Therefore, by modifying a peptide sequence to reduce occurrence of such degradation events, a the modified peptide or peptide-conjugate can have increased beneficial properties over unmodified peptides or peptide-drug conjugates, such as improved therapeutic efficacy, an increased safety profile, and can be less expensive to manufacture and develop. Key formulaic considerations that can prevent peptide decay can include the use of excipients, formulation at a desired pH, and storage under specific conditions (e.g., temperature, oxygen, light exposure, solid or liquid state, and container excipient materials). To circumvent degradation, peptide residues can be substituted with amino acids that increase stability, which can result in more efficacious and durable therapeutic peptides.

With respect to in vivo stability, the GI tract can contain a region of low pH (e.g. pH ˜1), a reducing environment, or a protease-rich environment that can degrade peptides and proteins. Proteolytic activity in other areas of the body, such as the mouth, eye, lung, intranasal cavity, skin, vaginal tract, mucous membranes, and serum, can also be an obstacle to the delivery of functionally active peptides and polypeptides. Additionally, the half-life of peptides in serum can be very short, in part due to proteases, such that the peptide can be degraded too quickly to have a lasting therapeutic effect when administering a therapeutic and safe dosing regimen. Likewise, proteolytic activity in cellular compartments such as lysosomes and reduction activity in lysosomes and the cytosol can degrade peptides and proteins such that they may be unable to provide a therapeutic function on intracellular targets. Therefore, peptides that are resistant to reducing agents, proteases, and low pH may be able to provide enhanced therapeutic effects or enhance the therapeutic efficacy of co-formulated or conjugated active agents in vivo.

Additionally, oral delivery of drugs can be desirable in order to target certain areas of the body (e.g., disease in the GI tract such as colon cancer, irritable bowel disorder, infections, metabolic disorders, and constipation) despite the obstacles to the delivery of functionally active peptides and polypeptides presented by this method of administration. For example, oral delivery of drugs can increase compliance by providing a dosage form that is more convenient for patients to take as compared to parenteral delivery. Oral delivery can be useful in treatment regimens that have a large therapeutic window. Therefore, peptides that are resistant to reducing agents, proteases, and low pH can allow for oral delivery of peptides without nullifying their therapeutic function.

Peptide Resistance to Reducing Agents. In some embodiments, a peptide of the present disclosure can be reduction resistant. Peptides of this disclosure can contain one or more cysteines, which can participate in disulfide bridges that can be integral to preserving the folded state of the peptide. Exposure of peptides to biological environments with reducing agents can result in unfolding of the peptide and loss of functionality and bioactivity. For example, glutathione (GSH) is a reducing agent that can be present in many areas of the body and in cells, and can reduce disulfide bonds. As another example, a peptide can become reduced upon cellular internalization during trafficking of a peptide across the gastrointestinal epithelium after oral administration. A peptide can become reduced upon exposure to various parts of the GI tract. The GI tract can be a reducing environment, which can inhibit the ability of therapeutic molecules with disulfide bonds to have optimal therapeutic efficacy, due to reduction of the disulfide bonds. A peptide can also be reduced upon entry into a cell, such as after internalization by endosomes or lysosomes or into the cytosol, or other cellular compartments. Reduction of the disulfide bonds and unfolding of the peptide can lead to loss of functionality or affect key pharmacokinetic parameters such as bioavailability, peak plasma concentration, bioactivity, and half-life. Reduction of the disulfide bonds can also lead to increased susceptibility of the peptide to subsequent degradation by proteases, resulting in rapid loss of intact peptide after administration. In some embodiments, a peptide that is resistant to reduction can remain intact and can impart a functional activity for a longer period of time in various compartments of the body and in cells, as compared to a peptide that is more readily reduced.

In certain embodiments, the peptides of this disclosure can be analyzed for the characteristic of resistance to reducing agents to identify stable peptides. In some embodiments, the peptides of this disclosure can remain intact after being exposed to different molarities of reducing agents such as 0.00001M-0.0001M, 0.0001M-0.001M, 0.001M-0.01M, 0.01 M-0.05 M, 0.05 M-0.1 M, for greater 15 minutes or more. In some embodiments, the reducing agent used to determine peptide stability can be dithiothreitol (DTT), Tris(2-carboxyethyl)phosphine HCl (TCEP), 2-Mercaptoethanol, (reduced) glutathione (GSH), or any combination thereof. In some embodiments, at least 5%-10%, at least 10%-20%, at least 20%-30%, at least 30%-40%, at least 40%-50%, at least 50%-60%, at least 60%-70%, at least 70%-80%, at least 80%-90%, or at least 90%-100% of the peptide remains intact after exposure to a reducing agent.

Peptide Resistance to Proteases. In some embodiments, a peptide of the present disclosure can be resistant to protease degradation. The stability of peptides of this disclosure can be determined by resistance to degradation by proteases. Proteases, also referred to as peptidases or proteinases, can be enzymes that can degrade peptides and proteins by breaking bonds between adjacent amino acids. Families of proteases with specificity for targeting specific amino acids can include serine proteases, cysteine proteases, threonine proteases, aspartic proteases, glutamic proteases, esterases, serum proteases, and asparagine proteases. Additionally, metalloproteases, matrix metalloproteases, elastase, carboxypeptidases, Cytochrome P450 enzymes, and cathepsins can also digest peptides and proteins. Proteases can be present at high concentration in blood, in mucous membranes, lungs, skin, the GI tract, the mouth, nose, eye, and in compartments of the cell. Misregulation of proteases can also be present in various diseases such as rheumatoid arthritis and other immune disorders. Degradation by proteases can reduce bioavailability, biodistribution, half-life, and bioactivity of therapeutic molecules such that they are unable to perform their therapeutic function. In some embodiments, peptides that are resistant to proteases can better provide therapeutic activity at reasonably tolerated concentrations in vivo.

In some embodiments, peptides of this disclosure can resist degradation by any class of protease. In certain embodiments, peptides of this disclosure resist degradation by pepsin (which can be found in the stomach), trypsin (which can be found in the duodenum), serum proteases, or any combination thereof. In certain embodiments, peptides of this disclosure can resist degradation by lung proteases (e.g., serine, cysteinyl, and aspartyl proteases, metalloproteases, neutrophil elastase, alpha-1 antitrypsin, secretory leucoprotease inhibitor, elafin), or any combination thereof. In some embodiments, the proteases used to determine peptide stability can be pepsin, trypsin, chymotrypsin, or any combination thereof. In some embodiments, at least 5%-10%, at least 10%-20%, at least 20%-30%, at least 30%-40%, at least 40%-50%, at least 50%-60%, at least 60%-70%, at least 70%-80%, at least 80%-90%, or at least 90%-100% of the peptide remains intact after exposure to a protease. Peptides of SEQ ID NO: 231, SEQ ID NO: 45, and SEQ ID NO: 132 can have particular structural qualities, which make them more resistant to protease degradation. For example, peptide of SEQ ID NO: 45 and SEQ ID NO: 133 exhibit the “hitchin” topology as described previously, which can be associated with resistance to protease and chemical degradation.

Peptide Stability in Acidic Conditions. Peptides of this disclosure can be administered in biological environments that are acidic. For example, after oral administration, peptides can experience acidic environmental conditions in the gastric fluids of the stomach and gastrointestinal (GI) tract. The pH of the stomach can range from ˜1-4 and the pH of the GI tract ranges from acidic to normal physiological pH descending from the upper GI tract to the colon. In addition, the vagina, late endosomes, and lysosomes can also hav acidic pH values, such as less than pH 7. The pH of various compartments of the kidney can also vary. These acidic conditions can lead to denaturation of peptides and proteins into unfolded states. Unfolding of peptides and proteins can lead to increased susceptibility to subsequent digestion by other enzymes as well as loss of biological activity of the peptide.

In certain embodiments, the peptides of this disclosure can resist denaturation and degradation in acidic conditions and in buffers, which simulate acidic conditions. In certain embodiments, peptides of this disclosure can resist denaturation or degradation in buffer with a pH less than 1, a pH less than 2, a pH less than 3, a pH less than 4, a pH less than 5, a pH less than 6, a pH less than 7, or a pH less than 8. In some embodiments, peptides of this disclosure remain intact at a pH of 1-3. In certain embodiments, at least 5%-10%, at least 10%-20%, at least 20%-30%, at least 30%-40%, at least 40%-50%, at least 50%-60%, at least 60%-70%, at least 70%-80%, at least 80%-90%, or at least 90%-100% of the peptide remains intact after exposure to a buffer with a pH less than 1, a pH less than 2, a pH less than 3, a pH less than 4, a pH less than 5, a pH less than 6, a pH less than 7, or a pH less than 8. In other embodiments, at least 5%-10%, at least 10%-20%, at least 20%-30%, at least 30%-40%, at least 40%-50%, at least 50%-60%, at least 60%-70%, at least 70%-80%, at least 80%-90%, or at least 90%-400% of the peptide remains intact after exposure to a buffer with a pH of 1-3. In other embodiments, the peptides of this disclosure can be resistant to denaturation or degradation in simulated gastric fluid (pH 1-2). In some embodiments, at least 5-10%, at least 10%-20%, at least 20%-30%, at least 30%-40%, at least 40%-50%, at least 50%-60%, at least 60%-70%, at least 70%-80%, at least 80%-90%, or at least 90-100% of the peptide remains intact after exposure to simulated gastric fluid. In some embodiments, low pH solutions such as simulated gastric fluid or citrate buffers can be used to determine peptide stability.

Peptide Stability at High Temperatures. In some embodiments, the peptides of the present disclosure are resistant to an elevated temperature. Peptides of this disclosure can be administered in biological environments with high temperatures. For example, after oral administration, peptides can experience high temperatures in the body. Body temperature can range from 36° C. to 40° C. High temperatures can lead to denaturation of peptides and proteins into unfolded states. Unfolding of peptides and proteins can lead to increased susceptibility to subsequent digestion by other enzymes as well as loss of biological activity of the peptide. In some embodiments, a peptide of this disclosure can remain intact at temperatures from 25° C. to 100° C. High temperatures can lead to faster degradation of peptides. Stability at a higher temperature can allow for storage of the peptide in tropical environments or areas where access to refrigeration is limited. In certain embodiments, 5%-100% of the peptide can remain intact after exposure to 25° C. for 6 months to 5 years. 5%-100% of a peptide can remain intact after exposure to 70° C. for 15 minutes to 1 hour. 5%-100% of a peptide can remain intact after exposure to 100° C. for 15 minutes to 1 hour. In other embodiments, at least 5%-10%, at least 10%-20%, at least 20%-30%, at least 30%-40%, at least 40%-50%, at least 50%-60%, at least 60%-70%, at least 70%-80%, at least 80%-90%, or at least 90%-100% of the peptide remains intact after exposure to 25° C. for 6 months to 5 years. In other embodiments, at least 5%-10%, at least 10%-20%, at least 20%-30%, at least 30%-40%, at least 40%-50%, at least 50%-60%, at least 60%-70%, at least 70%-80%, at least 80%-90%, or at least 90%-100% of the peptide remains intact after exposure to 70° C. for 15 minutes to 1 hour. In other embodiments, at least 5%-10%, at least 10%-20%, at least 20%-30%, at least 30%-40%, at least 40%-50%, at least 50%-60%, at least 60%-70%, at least 70%-80%, at least 80%-90%, or at least 90%-100% of the peptide remains intact after exposure to 100° C. for 15 minutes to 1 hour.

In some embodiments, the peptide of the peptide active agent conjugate comprises a sequence that has at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 97%, at least 99% or 100% sequence identity with any one of SEQ ID NO: 1-SEQ ID NO: 41 or a fragment thereof. In some embodiments, the peptide of the peptide active agent conjugate comprises a sequence that has at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 97%, at least 99% or 100% sequence identity with any one of SEQ ID NO: 42-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, or SEQ ID NO: 216-SEQ ID NO: 235, or a fragment thereof. In some embodiments, the peptide of the peptide active agent conjugate comprises a sequence that has at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 97%, at least 99% or 100% sequence identity with any one of SEQ ID NO: 236-SEQ ID NO: 276 or a fragment thereof. In some embodiments, the peptide of the peptide active agent conjugate comprises a sequence that has at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 97%, at least 99% or 100% sequence identity with any one of SEQ ID NO: 277-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 470, or a fragment thereof. In some embodiments, the peptide of the peptide active agent conjugate comprises a sequence that has at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 97%, at least 99% or 100% sequence identity with any one of SEQ ID NO: 471-SEQ ID NO: 529 or a fragment thereof. In some embodiments, the peptide of the peptide active agent conjugate comprises a sequence of any one of SEQ ID NO: 1-SEQ ID NO: 41 or a fragment thereof. In some embodiments, the peptide of the peptide active agent conjugate comprises a sequence of any one of SEQ ID NO: 42-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, or SEQ ID NO: 216-SEQ ID NO: 235, or a fragment thereof. In some embodiments, the peptide of the peptide active agent conjugate comprises a sequence of any one of SEQ ID NO: 236-SEQ ID NO: 276 or a fragment thereof. In some embodiments, the peptide of the peptide active agent conjugate comprises a sequence of any one of SEQ ID NO: 277-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 470, or a fragment thereof. In some embodiments, the peptide of the peptide active agent conjugate comprises a sequence of any one of SEQ ID NO: 471-SEQ ID NO: 529 or a fragment thereof. In some embodiments, the peptide of the peptide active agent conjugate comprises a sequence of any one of SEQ ID NO: 530-SEQ ID NO: 549 or SEQ ID NO: 570, or a fragment thereof. In some embodiments, the peptide of the peptide active agent conjugate comprises a sequence of any one of SEQ ID NO: 550-SEQ ID NO: 569 or a fragment thereof. In some embodiments, the peptide comprises a sequence that has at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 97%, at least 99%, or 100% sequence identity with any one of SEQ ID NO: 1-SEQ ID NO: 41 or a fragment thereof. In some embodiments, the peptide comprises a sequence that has at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 97%, at least 99%, or 100% sequence identity with any one of SEQ ID NO: 42-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, or SEQ ID NO: 216-SEQ ID NO: 235, or a fragment thereof. In some embodiments, the peptide comprises a sequence that has at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 97%, at least 99%, or 100% sequence identity with any one of SEQ ID NO: 236-SEQ ID NO: 276 or a fragment thereof. In some embodiments, the peptide comprises a sequence that has at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 97%, at least 99%, or 100% sequence identity with any one of SEQ ID NO: 277-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 470, or a fragment thereof. In some embodiments, the peptide comprises a sequence that has at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 97%, at least 99%, or 100% sequence identity with any one of SEQ ID NO: 471-SEQ ID NO: 529 or a fragment thereof. In some embodiments, the peptide comprises a sequence of any one of SEQ ID NO: 1-SEQ ID NO: 41 or a fragment thereof. In some embodiments, the peptide comprises a sequence of any one of SEQ ID NO: 42-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, or SEQ ID NO: 216-SEQ ID NO: 235, or a fragment thereof. In some embodiments, the peptide comprises a sequence of any one of SEQ ID NO: 236-SEQ ID NO: 276 or a fragment thereof. In some embodiments, the peptide comprises a sequence of any one of SEQ ID NO: 277-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 470, or a fragment thereof. In some embodiments, the peptide comprises a sequence of any one of SEQ ID NO: 471-SEQ ID NO: 529 or a fragment thereof. In some embodiments, the peptide comprises a sequence of any one of SEQ ID NO: 530-SEQ ID NO: 549 or SEQ ID NO: 570, or a fragment thereof. In some embodiments, the peptide comprises a sequence of any one of SEQ ID NO: 550-SEQ ID NO: 569 or a fragment thereof. In some embodiments, the peptide active agent conjugate or the peptide comprises a peptide with at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least 95%, at least, 97%, at least 98%, or at least 99% identical to any one of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 529.

Pharmacokinetics of Peptides

The pharmacokinetics of any of the peptides of this disclosure can be determined after administration of the peptide via different routes of administration. For example, the pharmacokinetic parameters of a peptide of this disclosure can be quantified after intravenous, subcutaneous, intramuscular, rectal, aerosol, parenteral, ophthalmic, pulmonary, transdermal, vaginal, optic, nasal, oral, sublingual, inhalation, dermal, intrathecal, intranasal, intra-articular, peritoneal, buccal, synovial, or topical administration. Peptides of the present disclosure can be analyzed by using tracking agents such as radiolabels or fluorophores. For example, a radiolabeled peptides of this disclosure can be administered via various routes of administration. Peptide concentration or dose recovery in various biological samples such as plasma, urine, feces, any organ, skin, muscle, and other tissues can be determined using a range of methods including HPLC, fluorescence detection techniques (TECAN quantification, flow cytometry, iVIS), or liquid scintillation counting.

The methods and compositions described herein can relate to pharmacokinetics of peptide administration via any route to a subject. Pharmacokinetics can be described using methods and models, for example, compartmental models or noncompartmental methods. Compartmental models include but are not limited to monocompartmental model, the two compartmental model, the multicompartmental model or the like. Models can be divided into different compartments and can be described by the corresponding scheme. For example, one scheme is the absorption, distribution, metabolism and excretion (ADME) scheme. For another example, another scheme is the liberation, absorption, distribution, metabolism and excretion (LADME) scheme. In some aspects, metabolism and excretion can be grouped into one compartment referred to as the elimination compartment. For example, liberation can include liberation of the active portion of the composition from the delivery system, absorption includes absorption of the active portion of the composition by the subject, distribution includes distribution of the composition through the blood plasma and to different tissues, metabolism, which includes metabolism or inactivation of the composition and finally excretion, which includes excretion or elimination of the composition or the products of metabolism of the composition. Compositions administered intravenously to a subject can be subject to multiphasic pharmacokinetic profiles, which can include but are not limited to aspects of tissue distribution and metabolism/excretion. As such, the decrease in plasma or serum concentration of the composition is often biphasic, including, for example an alpha phase and a beta phase, occasionally a gamma, delta or other phase is observed

Pharmacokinetics includes determining at least one parameter associated with administration of a peptide to a subject. In some aspects, parameters include at least the dose (D), dosing interval (τ), area under curve (AUC), maximum concentration (C_(max)), minimum concentration reached before a subsequent dose is administered (C_(min)), minimum time (T_(min)), maximum time to reach Cmax (T_(max)), volume of distribution (V_(d)), steady-state volume of distribution (V_(ss)), back-extrapolated concentration at time 0 (C₀), steady state concentration (C_(ss)), elimination rate constant (k_(c)), infusion rate (k_(in)), clearance (CL), bioavailability (f), fluctuation (% PTF) and elimination half-life (t_(1/2)).

In certain embodiments, the peptides of any of SEQ ID NO: 1-SEQ ID NO: 569 exhibit optimal pharmacokinetic parameters after oral administration. In other embodiments, the peptides of any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 569 exhibit optimal pharmacokinetic parameters after any route of administration, such as oral administration, inhalation, intranasal administration, topical administration, parenteral administration, intravenous administration, subcutaneous administration, intra-articular administration, intramuscular administration, intraperitoneal administration, transdermal administration, dermal administration, or any combination thereof.

In some embodiments any peptide of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 569 exhibits an average T_(max) of 0.5-12 hours, or 1-48 hours at which the C_(max) is reached, an average bioavailability in serum of 0.1%-10% in the subject after administering the peptide to the subject by an oral route, an average bioavailability in serum of less than 0.1% after oral administration to a subject for delivery to the GI tract, an average bioavailability in serum of 10-100% after parenteral administration, an average t^(½) of 0.1 hours-168 hours, or 0.25 hours-48 hours in a subject after administering the peptide to the subject, an average clearance (CL) of 0.5-100 L/hour or 0.5-50 L/hour of the peptide after administering the peptide to a subject, an average volume of distribution (V_(d)) of 200-20,000 mL in the subject after systemically administering the peptide to the subject, or optionally no systemic uptake, any combination thereof.

Methods of Manufacture

Various expression vector/host systems can be utilized for the production of the recombinant expression of peptides described herein. Non-limiting examples of such systems include microorganisms such as bacteria transformed with recombinant bacteriophage DNA, plasmid DNA or cosmid DNA expression vectors containing a nucleic acid sequence encoding peptides or peptide fusion proteins/chimeric proteins described herein, yeast transformed with recombinant yeast expression vectors containing the aforementioned nucleic acid sequence, insect cell systems infected with recombinant virus expression vectors (e.g., baculovirus) containing the aforementioned nucleic acid sequence, plant cell systems infected with recombinant virus expression vectors (e.g., cauliflower mosaic virus (CaMV), tobacco mosaic virus (TMV) or transformed with recombinant plasmid expression vectors (e.g., Ti plasmid) containing the aforementioned nucleic acid sequence, or animal cell systems infected with recombinant virus expression vectors (e.g., adenovirus, vaccinia virus) including cell lines engineered to contain multiple copies of the aforementioned nucleic acid sequence, either stably amplified (e.g., CHO/dhfr, CHO/glutamine synthetase) or unstably amplified in double-minute chromosomes (e.g., murine cell lines). Disulfide bond formation and folding of the peptide could occur during expression or after expression or both.

A host cell can be adapted to express one or more peptides described herein. The host cells can be prokaryotic, eukaryotic, or insect cells. In some cases, host cells are capable of modulating the expression of the inserted sequences, or modifying and processing the gene or protein product in the specific fashion desired. For example, expression from certain promoters can be elevated in the presence of certain inducers (e.g., zinc and cadmium ions for metallothionine promoters). In some cases, modifications (e.g., phosphorylation) and processing (e.g., cleavage) of peptide products can be important for the function of the peptide. Host cells can have characteristic and specific mechanisms for the post-translational processing and modification of a peptide. In some cases, the host cells used to express the peptides secretes minimal amounts of proteolytic enzymes.

In the case of cell- or viral-based samples, organisms can be treated prior to purification to preserve and/or release a target polypeptide. In some embodiments, the cells are fixed using a fixing agent. In some embodiments, the cells are lysed. The cellular material can be treated in a manner that does not disrupt a significant proportion of cells, but which removes proteins from the surface of the cellular material, and/or from the interstices between cells. For example, cellular material can be soaked in a liquid buffer or, in the case of plant material, can be subjected to a vacuum, in order to remove proteins located in the intercellular spaces and/or in the plant cell wall. If the cellular material is a microorganism, proteins can be extracted from the microorganism culture medium. Alternatively, the peptides can be packed in inclusion bodies. The inclusion bodies can further be separated from the cellular components in the medium. In some embodiments, the cells are not disrupted. A cellular or viral peptide that is presented by a cell or virus can be used for the attachment and/or purification of intact cells or viral particles. In addition to recombinant systems, Peptides can also be synthesized in a cell-free system using a variety of known techniques employed in protein and peptide synthesis.

In some cases, a host cell produces a peptide that has an attachment point for a drug. An attachment point could comprise a lysine residue, an N-terminus, a cysteine residue, a cysteine disulfide bond, or a non-natural amino acid. The peptide could also be produced synthetically, such as by solid-phase peptide synthesis, or solution-phase peptide synthesis. Peptide synthesis can also be performed by fluorenylmethyloxycarbonyl (Fmoc) chemistry or by butyloxycarbonyl (Boc) chemistry. The peptide could be folded (formation of disulfide bonds) during synthesis or after synthesis or both. Peptide fragments could be produced enzymatically or synthetically or recombinantly and then joined together synthetically, recombinantly, or via an enzyme.

FIG. 4 illustrates a schematic of a method of manufacturing a construct that expresses a peptide of the disclosure, such as the constructs illustrated in FIG. 3 and as described throughout the disclosure and in SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 569 provided herein.

In other aspects, the peptides of the present disclosure can be prepared by conventional solid phase chemical synthesis techniques, for example according to the Fmoc solid phase peptide synthesis method (“Fmoc solid phase peptide synthesis, a practical approach,” edited by W. C. Chan and P. D. White, Oxford University Press, 2000), by Boc solid phase peptide synthesis, or by conventional solution phase peptide synthesis. Refolding and disulfide bond formation can be executed by methods known in the art, such as incubation of the peptide at a mildly basic pH in the presence of a redox pair such as reduced and oxidized cysteine, either after cleavage and protecting group removal and purification, or while still on the resin. Peptide fragments can also be made synthetically or recombinantly and then joined together. [. The disulfide bonds can be formed after cleavage from the resin, such as by air oxidation or a buffer system with a set pH range such as from 7-10 and can contain a redox system such as glutathione/oxidized glutathione or cysteine/cystine. The disulfide bonds can also be formed by selective protection and deprotection of specific cysteine residues followed by oxidation or on the resin. The peptide can be purified, such as by reversed-phase chromatography at any one or more steps during the production process. The peptide can be isolated by lyophilization and can be in various salt forms, such as TFA salt or ammonium and acetate salt.

Pharmaceutical Compositions of Peptides and Peptide-Conjugates

A pharmaceutical composition of the disclosure can be a combination of any peptide or peptide-conjugate described herein, or a salt thereof, with other chemical components, such as carriers, stabilizers, diluents, dispersing agents, suspending agents, thickening agents, antioxidants, solubilizers, buffers, osmolytes, salts, surfactants, amino acids, encapsulating agents, bulking agents, cryoprotectants, and/or excipients. The pharmaceutical composition facilitates administration of a peptide or peptide-conjugate described herein to an organism. Pharmaceutical compositions can be administered in therapeutically-effective amounts as pharmaceutical compositions by various forms and routes including, for example, intravenous, subcutaneous, intramuscular, rectal, aerosol, parenteral, ophthalmic, pulmonary, transdermal, vaginal, optic, nasal, oral, sublingual, inhalation, dermal, intrathecal, intranasal, intra-articular, topical administration, or combination thereof. A pharmaceutical composition can be administered in a local or systemic manner, for example, via injection of the peptide described herein directly into an organ, optionally in a depot.

Parenteral injections can be formulated for bolus injection or continuous infusion. The pharmaceutical compositions can be in a form suitable for parenteral injection as a sterile suspension, solution or emulsion in oily or aqueous vehicles, and can contain formulatory agents such as suspending, stabilizing and/or dispersing agents. Pharmaceutical formulations for parenteral administration include aqueous solutions of a peptide described herein in water soluble form. Suspensions of peptides described herein can be prepared as oily injection suspensions. Suitable lipophilic solvents or vehicles include fatty oils such as sesame oil, or synthetic fatty acid esters, such as ethyl oleate or triglycerides, or liposomes. Aqueous injection suspensions can contain substances which increase the viscosity of the suspension, such as sodium carboxymethyl cellulose, sorbitol, or dextran. The suspension can also contain suitable stabilizers or agents which increase the solubility and/or reduces the aggregation of such peptides described herein to allow for the preparation of highly concentrated solutions. Alternatively, the peptides described herein can be lyophilized or in powder form for re-constitution with a suitable vehicle, e.g., sterile pyrogen-free water, before use. In some embodiments, a purified peptide is administered intravenously.

A peptide or peptide-conjugate of the disclosure can be applied directly to an organ, or an organ tissue or cells, such as brain or brain tissue or cancer cells, during a surgical procedure. The recombinant peptides described herein can be administered topically and can be formulated into a variety of topically administrable compositions, such as solutions, suspensions, lotions, gels, pastes, medicated sticks, balms, creams, and ointments. Such pharmaceutical compositions can contain solubilizers, stabilizers, tonicity enhancing agents, buffers and preservatives.

In practicing the methods of treatment or use provided herein, therapeutically-effective amounts of the peptide described herein described herein can be administered in pharmaceutical compositions to a subject suffering from a condition that affects the immune system. In some embodiments, the subject is a mammal such as a human. A therapeutically-effective amount can vary widely depending on the severity of the disease, the age and relative health of the subject, the potency of the compounds used, and other factors.

Pharmaceutical compositions can be formulated using one or more physiologically-acceptable carriers comprising excipients and auxiliaries, which facilitate processing of the active compounds into preparations that can be used pharmaceutically. Formulation can be modified depending upon the route of administration chosen. Pharmaceutical compositions comprising a peptide described herein can be manufactured, for example, by expressing the peptide in a recombinant system, purifying the peptide, lyophilizing the peptide, mixing, dissolving, granulating, dragee-making, levigating, emulsifying, encapsulating, entrapping, or compression processes. The pharmaceutical compositions can include at least one pharmaceutically acceptable carrier, diluent, or excipient and compounds described herein as free-base or pharmaceutically-acceptable salt form.

Methods for the preparation of peptides described herein comprising the compounds described herein include formulating the peptide or peptide-conjugates described herein, or a salt thereof, with one or more inert, pharmaceutically-acceptable excipients or carriers to form a solid, semi-solid, or liquid composition. Solid compositions include, for example, powders, tablets, dispersible granules, capsules, cachets, and suppositories. These compositions can also contain minor amounts of nontoxic, auxiliary substances, such as wetting or emulsifying agents, pH buffering agents, and other pharmaceutically-acceptable additives.

Non-limiting examples of pharmaceutically-acceptable excipients can be found, for example, in Remington: The Science and Practice of Pharmacy, Nineteenth Ed (Easton, Pa.: Mack Publishing Company, 1995); Hoover, John E., Remington's Pharmaceutical Sciences, Mack Publishing Co., Easton, Pa. 1975; Liberman, H. A. and Lachman, L., Eds., Pharmaceutical Dosage Forms, Marcel Decker, New York, N.Y., 1980; and Pharmaceutical Dosage Forms and Drug Delivery Systems, Seventh Ed. (Lippincott Williams & Wilkins 1999), each of which is incorporated by reference in its entirety.

Administration of Pharmaceutical Compositions

A pharmaceutical composition of the disclosure can be a combination of any peptide described herein with other chemical components, such as carriers, stabilizers, diluents, dispersing agents, suspending agents, thickening agents, and/or excipients. The pharmaceutical composition facilitates administration of a peptide described herein to an organism. Pharmaceutical compositions can be administered in therapeutically-effective amounts as pharmaceutical compositions by various forms and routes including, for example, intravenous, subcutaneous, intramuscular, rectal, aerosol, parenteral, ophthalmic, pulmonary, transdermal, vaginal, optic, nasal, oral, inhalation, dermal,intra-articular, intrathecal, intranasal, and topical administration. A pharmaceutical composition can be administered in a local or systemic manner, for example, via injection of the peptide described herein directly into an organ, optionally in a depot.

Parenteral injections can be formulated for bolus injection or continuous infusion. The pharmaceutical compositions can be in a form suitable for parenteral injection as a sterile suspension, solution or emulsion in oily or aqueous vehicles, and can contain formulatory agents such as suspending, stabilizing and/or dispersing agents. Pharmaceutical formulations for parenteral administration include aqueous solutions of a peptide described herein in water-soluble form. Suspensions of peptides described herein can be prepared as oily injection suspensions. Suitable lipophilic solvents or vehicles include fatty oils such as sesame oil, or synthetic fatty acid esters, such as ethyl oleate or triglycerides, or liposomes. Aqueous injection suspensions can contain substances which increase the viscosity of the suspension, such as sodium carboxymethyl cellulose, sorbitol, or dextran. The suspension can also contain suitable stabilizers or agents which increase the solubility and/or reduce the aggregation of such peptides described herein to allow for the preparation of highly concentrated solutions. Alternatively, the peptides described herein can be lyophilized or in powder form for re-constitution with a suitable vehicle, e.g., sterile pyrogen-free water, before use. In some embodiments, a purified peptide is administered intravenously. A peptide described herein can be administered to a subject, home, target, migrates to, is retained by, and/or binds to, or be directed to an organ, e.g., the kidney.

A peptide of the disclosure can be applied directly to an organ, or an organ tissue or cells, such as the kidney, kidney tissue, or cells, during a surgical procedure, such as kidney transplantation. The recombinant peptides described herein can be administered topically and can be formulated into a variety of topically administrable compositions, such as solutions, suspensions, lotions, gels, pastes, medicated sticks, balms, creams, and ointments. Such pharmaceutical compositions can contain solubilizers, stabilizers, tonicity enhancing agents, buffers and preservatives.

In practicing the methods of treatment or use provided herein, therapeutically-effective amounts of the peptide described herein described herein are administered in pharmaceutical compositions to a subject suffering from a condition. In some instances the pharmaceutical composition will affect the physiology of the animal, such as the immune system, inflammatory response, or other physiologic affect. In some embodiments, the subject is a mammal such as a human. A therapeutically-effective amount can vary widely depending on the severity of the disease, the age and relative health of the subject, the potency of the compounds used, and other factors.

Pharmaceutical compositions can be formulated using one or more physiologically-acceptable carriers comprising excipients and auxiliaries, which facilitate processing of the active compounds into preparations that can be used pharmaceutically. Formulation can be modified depending upon the route of administration chosen. Pharmaceutical compositions comprising a peptide described herein can be manufactured, for example, by expressing the peptide in a recombinant system, purifying the peptide, lyophilizing the peptide, mixing, dissolving, granulating, dragee-making, levigating, emulsifying, encapsulating, entrapping, or compression processes. The pharmaceutical compositions can include at least one pharmaceutically acceptable carrier, diluent, or excipient and compounds described herein as free-base or pharmaceutically-acceptable salt form.

Methods for the preparation of peptides described herein comprising the compounds described herein include formulating the peptide described herein with one or more inert, pharmaceutically-acceptable excipients or carriers to form a solid, semi-solid, or liquid composition. Solid compositions include, for example, powders, tablets, dispersible granules, capsules, cachets, and suppositories. These compositions can also contain minor amounts of nontoxic, auxiliary substances, such as wetting or emulsifying agents, pH buffering agents, and other pharmaceutically-acceptable additives.

Non-limiting examples of pharmaceutically-acceptable excipients can be found, for example, in Remington: The Science and Practice of Pharmacy, Nineteenth Ed (Easton, Pa.: Mack Publishing Company, 1995); Hoover, John E., Remington's Pharmaceutical Sciences, Mack Publishing Co., Easton, Pa. 1975; Liberman, H. A. and Lachman, L., Eds., Pharmaceutical Dosage Forms, Marcel Decker, New York, N.Y., 1980; and Pharmaceutical Dosage Forms and Drug Delivery Systems, Seventh Ed. (Lippincott Williams & Wilkins 1999), each of which is incorporated by reference in its entirety.

Use of Peptide in Imaging and Surgical Methods

The present disclosure generally relates to peptides that home, target, migrate to, are retained by, accumulate in, and/or bind to, or are directed to specific regions, tissues, structures, or cells within the body and methods of using such peptides. These peptides can contact the kidney, which can make them useful for a variety of applications. In particular, the peptides can have applications in site-specific modulation of biomolecules to which the peptides are directed to. End uses of such peptides can include, for example, imaging, research, therapeutics, theranostics, pharmaceuticals, chemotherapy, chelation therapy, targeted drug delivery, and radiotherapy. Some uses can include targeted drug delivery and imaging.

In some embodiments, the present disclosure provides a method for detecting a cancer, cancerous tissue, or tumor tissue, the method comprising the steps of contacting a tissue of interest with a peptide of the present disclosure, wherein the peptide is conjugated to a detectable agent and measuring the level of binding of the peptide, wherein an elevated level of binding, relative to normal tissue, is indicative that the tissue is a cancer, cancerous tissue or tumor tissue.

In some embodiments, the disclosure provides a method of imaging an organ or body region or region, tissue or structure of a subject, the method comprising administrating to the subject the peptide or a pharmaceutical composition disclosed herein and imaging the subject. In some embodiments such imaging is used to detect a condition associated with a function of the kidney. In some cases the condition is an inflammation, a cancer, a degradation, a growth disturbance, genetic, a tear or an injury, or another suitable condition. In some cases the condition can be Systemic Lupus Erythematosus (SLE or “Lupus”), or another suitable condition. In some case the condition can be associated with a cancer or tumor of the kidney. In some embodiments, such as those associated with cancers, the imaging can be associated with surgical removal of the diseased region, tissue, structure or cell of a subject.

Furthermore, the present disclosure provides methods for intraoperative imaging and resection of a diseased or inflamed tissue, cancer, cancerous tissue, or tumor tissue using a peptide of the present disclosure conjugated with a detectable agent. In some embodiments, the diseased or inflamed tissue, cancer, cancerous tissue, or tumor tissue is detectable by fluorescence imaging that allows for intraoperative visualization of the cancer, cancerous tissue, or tumor tissue using a peptide of the present disclosure. In some embodiments, the peptide of the present disclosure is conjugated to one or more detectable agents. In a further embodiment, the detectable agent comprises a fluorescent moiety coupled to the peptide. In another embodiment, the detectable agent comprises a radionuclide. In some embodiments, imaging is achieved during open surgery. In further embodiments, imaging is accomplished using endoscopy or other non-invasive surgical techniques.

Renal Therapy with Peptides and Peptide-Conjugates

As discussed above and herein, the present disclosure provides peptides that home, target, migrate to, accumulate in, are directed to, and/or bind to specific regions, tissues, structures, or cells of the kidney and methods of using such peptides. End uses of such peptides include, for example, imaging, research, therapeutics, diagnostics, theranostics, pharmaceuticals, chemotherapy, chelation therapy, targeted drug delivery, and radiotherapy.

In one embodiment, the method includes administering an effective amount of a peptide of the present disclosure to a subject in need thereof. The term “effective amount,” as used herein, can refer to a sufficient amount of an agent or a compound being administered which will relieve to some extent one or more of the symptoms of the disease or condition being treated. The result can be reduction and/or alleviation of the signs, symptoms, or causes of a disease, or any other desired alteration of a biological system. Compositions containing such agents or compounds can be administered for prophylactic, enhancing, and/or therapeutic treatments. An appropriate “effective” amount in any individual case can be determined using techniques, such as a dose escalation study.

The methods, compositions, and kits of this disclosure can comprise a method to prevent, treat, arrest, reverse, or ameliorate the symptoms of a condition. The treatment can comprise treating a subject (e.g., an individual, a domestic animal, a wild animal or a lab animal afflicted with a disease or condition) with a peptide of the disclosure. In treating a disease, the peptide can contact the kidney of a subject. The subject can be a human. A subject can be a human; a non-human primate such as a chimpanzee, or other ape or monkey species; a farm animal such as a cattle, horse, sheep, goat, swine; a domestic animal such as a rabbit, dog, and cat; a laboratory animal including a rodent, such as a rat, mouse and guinea pig, or the like. A subject can be of any age. A subject can be, for example, an elderly adult, adult, adolescent, pre-adolescent, child, toddler, infant, or fetus in utero.

Treatment can be provided to the subject before clinical onset of disease. Treatment can be provided to the subject after clinical onset of disease. Treatment can be provided to the subject after 1 day, 1 week, 6 months, 12 months, or 2 years or more after clinical onset of the disease. Treatment may be provided to the subject for more than 1 day, 1 week, 1 month, 6 months, 12 months, 2 years or more after clinical onset of disease. Treatment may be provided to the subject for less than 1 day, 1 week, 1 month, 6 months, 12 months, or 2 years after clinical onset of the disease. Treatment can also include treating a human in a clinical trial. A treatment can comprise administering to a subject a pharmaceutical composition, such as one or more of the pharmaceutical compositions described throughout the disclosure. A treatment can comprise a once daily dosing. A treatment can comprise delivering a peptide of the disclosure to a subject, either parenterally, intravenously, subcutaneously, intramuscularly, by inhalation, dermally, intra-articular injection, orally, intrathecally, transdermally, intranasally, via a peritoneal route, or directly, e.g., via topical, intra-articular injection route or injection route of application. A treatment can comprise administering a peptide-active agent complex to a subject, either parenterally, intravenously, subcutaneously, intramuscularly, by inhalation, dermally, intra-articular injection, orally, intrathecally, transdermally, intranasally, via a peritoneal route, or directly onto, near or into the kidney, e.g., via topical, intra-articular injection, or injection route of application or during surgery .

In some embodiments, the present disclosure provides a method for treating a cancer, the method comprising administering to a subject in need thereof an effective amount of a peptide of the present disclosure.

In some embodiments, the present disclosure provides a method for treating a cancer, the method comprising administering to a patient in need thereof an effective amount of a pharmaceutical composition comprising a peptide of the present disclosure and a pharmaceutically acceptable carrier.

In some embodiments, the present disclosure provides a method for inhibiting invasive activity of cells, the method comprising administering an effective amount of a peptide of the present disclosure to a subject.

In some embodiments, the peptides of the present disclosure are conjugated to one or more therapeutic agents. In further embodiments, the therapeutic agent is a chemotherapeutic, anti-cancer drug, or anti-cancer agent selected from, but are not limited to: anti-inflammatories, such as for example a glucocorticoid, a corticosteroid, a protease inhibitor, such as for example collagenase inhibitor or a matrix metalloprotease inhibitor (i.e., MMP-13 inhibitor), an amino sugar, vitamin (e.g., Vitamin D), and antibiotics, antiviral, or antifungal, a statin, an immune modulator, radioisotopes, toxins, enzymes, sensitizing drugs, nucleic acids, including interfering RNAs, antibodies, anti-angiogenic agents, cisplatin, anti-metabolites, mitotic inhibitors, growth factor inhibitors, paclitaxel, temozolomide, topotecan, fluorouracil, vincristine, vinblastine, procarbazine, decarbazine, altretamine, methotrexate, mercaptopurine, thioguanine, fludarabine phosphate, cladribine, pentostatin, cytarabine, azacitidine, etoposide, teniposide, irinotecan, docetaxel, doxorubicin, daunorubicin, dactinomycin, idarubicin, plicamycin, mitomycin, bleomycin, tamoxifen, flutamide, leuprolide, goserelin, aminogluthimide, anastrozole, amsacrine, asparaginase, mitoxantrone, mitotane and amifostine, and their equivalents, as well as photo-ablation. Some of these active agents induce programmed cell death such as apoptosis in target cells and thereby improve symptoms or ameliorate disease. Apoptosis can be induced by many active agents, including, for example, chemotherapeutics, anti-inflammatories, corticosteroids, NSAIDS, tumor necrosis factor alpha (TNF-α) modulators, tumor necrosis factor receptor (TNFR) family modulators. In some embodiments, peptides of this disclosure can be used to target active agents to pathways of cell death or cell killing, such as caspases, apoptsis activators and inhibitors, XBP-1, Bcl-2, Bcl-Xl, Bcl-w, and other disclosed herein. In other embodiments, the therapeutic agent is any nonsteroidal anti-inflammatory drug (NSAID). The NSAID can be any heterocyclic acetic acid derivatives such as ketorolac, indomethacin, etodolac, or tolemetin, any propionic acid derivatives such as naproxen, any enolic acid derivatives, any anthranilic acid derivatives, any selective COX-2 inhibitors such as celecoxib, any sulfonanilides, any salicylates, aceclofenac, nabumetone, sulindac, diclofenac, or ibuprofen. In other embodiments, the therapeutic agent is any steroid, such as dexamethasone, budesonide, beclomethasone monopropionate, desciclesonide, triamcinolone, cortisone, prednisone, rednisolone, triamcinolone hexacetonide, or methylprednisolone. In other embodiments, the therapeutic agent is a pain reliever, such as acetaminophen, opioids, local anesthetics, anti-depressants, glutamate receptor antagonists, adenosine, or neuropeptides. In some embodiments, a treatment consists of administering a combination of any of the above therapeutic agents and a peptide conjugate, such as a treatment in which both a dexamethasone-peptide conjugate and an NSAID are administered to a patient. Peptides of the current disclosure that target the kidney can be used to treat the diseases conditions as described herein, for example, any diseases or conditions including tears, injuries (i.e., sports injuries), genetic factors, degradation, thinning, inflammation, cancer or any other disease or condition of the kidney or to target therapeutically-active substances to treat these diseases amongst others. In some cases, the peptide or peptide-active agent can be used to target cancer in the kidney, by contacting the kidney and then having antitumor function, targeted toxicity, inhibiting metastases, etc. As well, such peptide or peptide-active agent can be used to label, detect, or image such kidney lesions, including tumors and metastases amongst other lesions, which may be removed through various surgical techniques or by targeting with peptide-active agents that induce programmed cell death or kill cells.

Venom or toxin derived peptide(s), peptides, modified peptides, labeled peptides, peptide-active agent conjugates and pharmaceutical compositions described herein can be administered for prophylactic and/or therapeutic treatments. In therapeutic applications, the composition can be administered to a subject already suffering from a disease or condition, in an amount sufficient to cure or at least partially arrest the symptoms of the disease or condition, or to cure, heal, improve, or ameliorate the condition. Such peptides described herein can also be administered to prevent (either in whole or in part), lessen a likelihood of developing, contracting, or worsening a condition. Amounts effective for this use can vary based on the severity and course of the disease or condition, previous therapy, the subject's health status, weight, response to the drugs, and the judgment of the treating physician. Venom or toxin derived peptide(s), peptides, modified peptides, labeled peptides, peptide-active agent conjugates and pharmaceutical compositions described herein can allow for targeted homing of the peptide and local delivery of any conjugate. For example, a peptide conjugated to a steroid allows for local delivery of the steroid, which is significantly more effective and less toxic than traditional systemic steroids. A peptide conjugated to an NSAID is another example. In this case, the peptide conjugated to an NSAID allows for local delivery of the NSAID, which allows for administration of a lower NSAID dose and is subsequently less toxic. By delivering an active agent to the kidney, pain relief can be more rapid, may be more long lasting, and can be obtained with a lower systemic dose and off-site undesired effects than with systemic dosing without targeting.

Peptides of the current disclosure can be used to treat or manage pain associated with a kidney injury or disorder, or any other kidney condition as described herein. The peptides can be used either directly or as carriers of active drugs, peptides, or molecules. For example, since ion channels can be associated with pain and can be activated in disease states, peptides that interact with ion channels can be used directly to reduce pain. In another embodiment, the peptide is conjugated to an active agent with anti-inflammatory activity, in which the peptide acts as a carrier for the local delivery of the active agent to reduce pain.

In some embodiments, the peptides described herein provide a method of treating a kidney condition of a subject, the method comprising administering to the subject a therapeutically-effective amount of a peptide comprising the sequence of GSGVX¹IX²X³RCX⁴GSRDCX⁵DPCRX⁶X⁷X⁸GX⁹RX¹⁰GRCX¹¹NRRCRCX¹²X¹³X¹⁴X¹⁵ (SEQ ID NO: 570) or fragment thereof, wherein X1, X2, X3, X4, X5, X6, X7, X8, X9, X10, X11, X12, X13, X14 and X15 are each individually any amino acid or amino acid analogue or null. In some embodiments, the peptides described herein provide a method of treating a kidney condition of a subject, the method comprising administering to the subject a peptide of any one of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 569 or fragment thereof.

Treatment of Kidney Disorders

In some embodiments, peptides of this disclosure that home, target, are directed to, migrate to, are retained by, accumulate in, or bind to specificregions, tissues, structures, or cells of the kidneys can be used to treat a kidney disorder. In other embodiments, peptides are used in peptide conjugates of the present disclosure to deliver an active agent for treatment of a kidney disorder.

In some embodiments, the peptides and peptide-conjugates of the present disclosure are used to treat a condition of the kidney, or a region, tissue, structure, or cell thereof. In certain embodiments, the condition is associated with kidney or a function of a subject's kidneys. The present disclosure encompasses various acute and chronic renal diseases, including glomerular, tubule-interstitial, and microvascular diseases. Examples of conditions applicable to the present disclosure include but are not limited to: hypertensive kidney damage, acute kidney diseases and disorders (AKD), acute kidney injury (AKI) due to ischemia-reperfusion injury, drug treatment such as chemotherapy, cardiovascular surgery, surgery, medical interventions or treatment, radiocontrast nephropathy, or induced by cisplatin or carboplatin, which can be treated prophylactically, established AKI including ischemic renal injury, endotoxemia-induced AKI, endotoxemia/sepsis syndrome, or established nephrotoxic AKI (e.g. rhabdomyolysis, radiocontrast nephropathy, cisplatin/carboplatin AKI, aminoglycoside nephrotoxicity), end stage renal disease, acute and rapidly progressive glomerulonephritis, acute presentations of nephrotic syndrome, acute pyelonephritis, acute renal failure, chronic glomerulonephritis, chronic heart failure, chronic interstitial nephritis, graft versus host disease after renal transplant, chronic kidney disease (CKD) such as diabetic nephropathy, hypertensive nephrosclerosis, idiopathic chronic glomerulonephritis (e.g. focal glomerular sclerosis, membranous nephropathy, membranoproliferative glomerulonephritis, minimal change disease transition to chronic disease, anti-GBM disease, rapidly progressive cresentic glomerulonephritis, IgA nephropathy), secondary chronic glomerulonephritis (e.g. systemic lupus, polyarteritis nodosa, scleroderma, amyloidosis, endocarditis), hereditary nephropathy (e.g. polycystic kidney disease, Alport's syndrome), interstitial nephritis induced by drugs (e.g. Chinese herbs, NSAIDs), multiple myeloma or sarcoid, or renal transplantation such as donor kidney prophylaxis (treatment of donor kidney prior to transplantation), treatment post transplantation to treat delayed graft function, acute rejection, or chronic rejection, chronic liver disease, chronic pyelonephritis, diabetes, diabetic kidney disease, fibrosis, focal sclerosis, focal segmental glomerulosclerosis, Goodpasture's disease, hypertensive nephrosclerosis, IgG4-related renal disease, interstitial inflammation, lupus nephritis, nephritic syndrome, partial obstruction of the urinary tract, polycystic kidney disease, progressive renal disease, renal cell carcinoma, clear cell renal cell carcinoma, papillary renal cell carincoma, chromophobe renal cell carinoma, kidney cancer, transitional cell carcinoma, nephroblastoma, renal sarcoma, renal adenoma, oncocytoma, angiomyolipoma, renal fibrosis, kidney stones, hypertension, hypotension, disorders of sodium, water, acid-base, potassium, calcium, magnesium, or phosphate balance, infections, urinary tract infections, kidney failure, hematuria, renal cysts, uremia, shock, uretal obstruction, proteinuria, Fanconi's syndrome, Bartter's syndrome, chronic renal insufficiency, renal fibrosis, and vasculitis. For example, in certain embodiments, the peptides and peptide-conjugates of the present disclosure are used to reduce acute kidney injury in order to prevent it from progressing to chronic kidney disease.

Alternatively or in combination, in some embodiments, the peptide and peptide-conjugates of the present disclosure are used to elicit a protective response such as ischemic preconditioning and/or acquired cytoresistance in a kidney of the subject. In some embodiments, ischemic preconditioning and/or acquired cytoresistance is induced by administering an agent (e.g., a peptide or peptide-conjugate of the present disclosure) that upregulates the expression of protective stress proteins, such as antioxidants, anti-inflammatory proteins, or protease inhibitors. In certain embodiments, the induced response protects the kidney by preserving kidney function in whole or in part and/or by reducing injury to renal tissues and cells, e.g., relative to the situation where no protective response is induced. The peptides and peptide-conjugates of the present disclosure can provide certain benefits compared to other agents for inducing ischemic preconditioning and/or acquired cytoresistance, such as a well-defined chemical structure and avoidance of low pH precipitation.

In some embodiments, the protective response is induced in order to protect the kidney or tissues or cells thereof from an injury or insult that is predicted to occur (e.g., associated with a planned event such as a medical procedure, is likely to occur due to a condition in the subject) or has already occurred. In certain embodiments, the induced response prevents or reduces the extent of damage to the kidney or tissues or cells thereof caused by the injury or insult. For instance, in certain embodiments, the peptides and peptide-conjugates induce acquired cytoresistance by activating protective pathways and/or upregulating expression of protective stress proteins. Optionally, the peptides and peptide-conjugates are capable of inducing such protective responses while causing minimal or no injury to the kidney.

In various embodiments, the injury or insult is associated with one or more of: surgery, radiocontrast imaging, cardiopulmonary bypass, balloon angioplasty, induced cardiac or cerebral ischemic-reperfusion injury, organ transplantation, sepsis, shock, low blood pressure, high blood pressure, kidney hypoperfusion, chemotherapy, drug administration, nephrotoxic drug administration, blunt force trauma, puncture, poison, or smoking. For instance, in certain embodiments, the injury or insult is associated with a medical procedure that has been or will be performed on the subject, such as one or more of: surgery, radiocontrast imaging, cardiopulmonary bypass, balloon angioplasty, induced cardiac or cerebral ischemic-reperfusion injury, organ transplantation, chemotherapy, drug administration, or nephrotoxic drug administration.

In some embodiments, the peptide itself exhibits a renal therapeutic effect. For example, in certain embodiments, the cystine-dense peptide interacts with a renal ion channel, inhibits a protease, has antimicrobial activity, has anticancer activity, has anti-inflammatory activity, induces ischemic preconditioning or acquired cytoresistance, or produces a protective or therapeutic effect on a kidney of the subject, or a combination thereof. Optionally, the renal therapeutic effect exhibited by the peptide is a renal protective effect or renal prophylactic effect (e.g., ischemic preconditioning or acquired cytoresistance) that protects the kidney or a tissue or cell thereof from an upcoming injury or insult. Such effects based upon the peptide in and of itself can be used to enhance the therapeutic effect of active agents that may be conjugated, linked, or grafted to the peptides disclosed herein.

For example, in certain embodiments, a peptide of the present disclosure activates protective pathways and/or upregulates expression of protective stress proteins in the kidney or tissues or cells thereof. As another example, in certain embodiments, a peptide of the present disclosure accesses and suppresses intracellular injury pathways. In yet another example, in certain embodiments, a peptide of the present disclosure inhibits interstitial inflammation and prevents renal fibrosis. As a further example, in certain embodiments, a peptide of the present disclosure is administered prior to or currently with the administration of a nephrotoxic agent (e.g., aminoglycoside antibiotics such as gentamicin and minocycline, chemotherapeutics such as cisplatin, immunoglobulins or fragments thereof, mannitol, NSAIDs such as ketorolac or ibuprofen, cyclosporin, cyclophosphamide, radiocontrast dyes) in order to minimize its damaging effects, e.g., by blocking megalin-cubulin binding sites so that the nephrotoxic agent passes through the kidneys.

Alternatively or in combination, in some embodiments, the peptide is conjugated to a renal therapeutic agent that exhibits a renal therapeutic effect. In certain embodiments, the renal therapeutic agent is used to treat a condition of the kidney, or a region, tissue, structure, or cell thereof, such as the conditions provided herein. Examples of such renal therapeutic agents include but are not limited to: dexamethasone, a steroid, an anti-inflammatory agent, an antioxidant (e.g., glutathione, N acetyl cysteine), deferoxamine, feroxamine, iron, tin, a metal, a metal chelate, ethylene diamine tetraacetic acid (EDTA), an EDTA-Fe complex, dimercaptosuccinic acid (DMSA), 2,3-dimercapto-1-propanesulfonic acid (DMPS), penicillamine, an antibiotic such as gentamicin, vancomycin, minocin or mitomyclin, an iron chelator, a porphyrin, hemin, vitamin B12, a chemotherapeutic, an Nrf2 pathway activator such as bardoxolone, angiotensin-converting-enzyme (ACE) inhibitors such as ramipril, captopril, lisinopril, benazepril, quinapril, fosinopril, trandolapril, moexipril, enalaprilat, enalapril maleate, or perindopril erbumine, glycine polymers, or a combination thereof. Additional examples of a therapeutic agent that can be conjugated to the peptide can include QPI-1002, QM56, SVT016426 (QM31), 16/86 (third generation ferrostatin), BASP siRNA, CCX140, BIIB023, CXA-10, alkaline phosphatase, Dnmt1 inhibitor, THR-184, lithium, formoterol, IL-22, EPO and EPO derivatives, agents that stimulate erthyropoietin such as epoeitn alfa or darbepoietin alfa, PDGF inhibitors, CRMD-001, Atrasentan, Tolvaptan, RWJ-676070, Abatacept, Sotatercept, an anti-infective agent, an anti-viral agent, an anti-fungal agent, an aminoglycoside, an immunosuppresant such tacrolimus, mycophenolic acid (e.g., mycophenolate mofetil), cyclosporine A, or azathioprine, a diuretic drug such as thiazides, bemetanide, ethacrynic acid, furosemide, torsemide, glucose, mannitol, amiloride, spironolactone, eplerenone, triamterene, potassium canrenoate, bendroflumethiazide, hydrochlorothiazide, vasopressin, amphotericin B, acetazolamide, tovaptan, conivaptan, dopamine, dorzolamide, bendrolumethiazide, hydrochlorothiazide, caffeine, theophylline, or theobromine, a statin, a senolytic such as navitoclax or obatoclax, a corticosteroid such as prednisone, betamethasone, fludrocortisone, deoxycorticosterone, aldosterone, cortisone, hydrocortisone, belcometasone, dexamethasone, mometasone, fluticasone, prednisolone, methylprednisolone, triamcinolone acetonide or triamcinolone, a glucocorticoid, a liposome, renin, SGLT2 modulator, or angiotensin.

For example, in some embodiments, a peptide of the present disclosure is conjugated to an anti-inflammatory agent such as dexamethasone in order to treat lupus affecting the kidney, vasculitis, Goodpasture's disease, focal segmental glomerulosclerosis, nephritic syndrome, or other renal disorders caused by inflammatory processes. As another example, in some embodiments, a peptide of the present disclosure is conjugated to chemotherapeutic for treating renal cell carcinoma. As a further example, in some embodiments, a peptide of the present disclosure is conjugated to a steroid for treating polycystic renal disease.

In certain embodiments, the renal therapeutic agent is a renal protective agent or renal prophylactic agent capable of eliciting a protective response in the kidney upon administration to a subject. As discussed above and herein, the protective response can protect the kidney or a tissue or cell thereof from an upcoming injury or insult. For example, the renal protective agent or renal prophylactic agent can activate protective pathways and/or upregulate expression of protective stress proteins in the kidney or tissues or cells thereof. Examples of such renal protective agents and renal prophylactic agents include but are not limited to: dexamethasone, a steroid, an anti-inflammatory agent, a nonsteroidal anti-inflammatory drug (NSAID) such as ketorolac or ibuprofen, deferoxamine, iron, tin, a metal, a metal chelate, ethylene diamine tetraacetic acid (EDTA), an EDTA-Fe complex, dimercaptosuccinic acid (DMSA), 2,3-dimercapto-1-propanesulfonic acid (DMPS), penicillamine, an antibiotic, an aminoglycoside, an iron chelator, a porphyrin, vitamin B12, or a combination thereof. In some embodiments, the renal protective agent or renal prophylactic agent comprises complexed or chelated iron, (e.g., via heme, deferoxamine, feroxamine, porphyrin, EDTA, etc.). In such embodiments, the peptide-conjugate can be used to deliver iron to the renal tissue for kidney preconditioning.

For example, in certain embodiments, a peptide of the present disclosure is conjugated to hemin, which signals through the heat shock/heme reactive element pathway in order to upregulate a set of diverse cytoprotective proteins. As another example, in certain embodiments, a peptide of the present disclosure is conjugated to an iron chelate or iron complex in order to deliver iron to the kidney to alter gene expression profiles and induce expression of cytoprotective proteins.

The peptides of the present disclosure enable specific targeting of renal therapeutic agents and other agents to the kidneys, which in some embodiments is beneficial for reducing undesirable effect associated with systemic delivery and/or delivery to non-target tissues. For example, patients with inflammation-driven renal diseases that are currently treated with systemic steroids can benefit from peptide-steroid conjugates of the present disclosure that would deliver the therapeutic specifically to the kidneys at sufficiently high concentrations to elicit a targeted therapeutic effect, while reducing acute systemic side effects. In patients suffering from chronic disease, this approach can advantageously spare much of the rest of the body from side effects associated with long-term use of steroidal compounds. As another example, the peptide-conjugates of the present disclosure can be used for targeted delivery of iron for kidney preconditioning, thus reducing or preventing toxicity associated with systemic iron delivery.

In some embodiments, a method of treating a condition in a subject in need thereof comprises administering to the subject a composition or pharmaceutical composition comprising any of the peptides or peptide-conjugates described herein. For example, in certain embodiments, the composition comprises any of the peptides described herein. Optionally, the composition comprises a moiety coupled to the peptide, such as an active agent (e.g., a renal therapeutic agent) or any other moiety described herein. In various embodiments, the pharmaceutical composition comprises any composition of the present disclosure or a salt thereof, and any of pharmaceutically acceptable carriers described herein. In various embodiments, the composition or pharmaceutical composition homes, targets, is directed to, accumulates in, migrates to, is retained by, or binds to the renal tissue of the subject following administration. The composition or pharmaceutical composition can provide a therapeutic effect on the renal tissue in order to treat the condition, as discussed above and herein.

In some embodiments, a method of protecting a kidney of a subject from injury comprises administering to the subject a composition or pharmaceutical composition comprising any of the peptides or peptide-conjugates described herein. For example, in certain embodiments, the composition comprises any of the peptides described herein. Optionally, the composition comprises a moiety coupled to the peptide, such as an active agent (e.g., a renal therapeutic agent) or any other moiety described herein. In various embodiments, the pharmaceutical composition comprises any composition of the present disclosure or a salt thereof, and any of pharmaceutically acceptable carriers described herein.

In some embodiments, the method further comprises inducing ischemic preconditioning and/or acquired cytoresistance in the kidney of the subject. The ischemic preconditioning and/or acquired cytoresistance can protect the kidney from an injury or insult, as described above and herein. The methods of the present disclosure allow such protective responses to be preemptively induced in order to protect the kidney from an upcoming injury or insult. For example, in certain embodiments, the composition or pharmaceutical composition is administered at least 1 hour, at least 2 hours, at least 3 hours, at least 4 hours, at least 5 hours, at least 6 hours, at least 7 hours, at least 8 hours, at least 9 hours, at least 10 hours, at least 11 hours, at least 12 hours, at least 13 hours, at least 14 hours, at least 15 hours, at least 16 hours, at least 17 hours, at least 18 hours, at least 19 hours, at least 20 hours, at least 21 hours, at least 22 hours, at least 23 hours, at least 24 hours, at least 36 hours, at least 48 hours, at least 60 hours, at least 72 hours, or at least 96 hours prior to a predicted occurrence of the injury or insult.

Alternatively or in combination, the present disclosure includes methods for inducing a protective response in order to treat an injury or insult that has already occurred. For example, in certain embodiments, the composition or pharmaceutical composition is administered at least 1 hour, at least 2 hours, at least 3 hours, at least 4 hours, at least 5 hours, at least 6 hours, at least 7 hours, at least 8 hours, at least 9 hours, at least 10 hours, at least 11 hours, at least 12 hours, at least 13 hours, at least 14 hours, at least 15 hours, at least 16 hours, at least 17 hours, at least 18 hours, at least 19 hours, at least 20 hours, at least 21 hours, at least 22 hours, at least 23 hours, at least 24 hours, at least 36 hours, at least 48 hours, at least 60 hours, at least 72 hours, or at least 96 hours after an occurrence of the injury or insult.

In some embodiments, the present disclosure provides that any peptide of the disclosure including SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 569 can as a peptide conjugate with an active agent for treatment of a kidney disorder. For example, a peptide of SEQ ID NO: 45, SEQ ID NO: 132, or SEQ ID NO: 231 can be conjugated to an active agent and administered to a subject in need thereof to treat a kidney disorder.

In some embodiments, the method further comprises performing a medical procedure on the subject. The medical procedure can potentially cause injury or insult to the subject's kidneys. The method of the present disclosure can be used to induce a protective response in order to protect the kidneys from an injury or insult associated with an upcoming medical procedure. For example, in certain embodiments, the composition or the pharmaceutical composition is administered at least 1 hour, at least 2 hours, at least 3 hours, at least 4 hours, at least 5 hours, at least 6 hours, at least 7 hours, at least 8 hours, at least 9 hours, at least 10 hours, at least 11 hours, at least 12 hours, at least 13 hours, at least 14 hours, at least 15 hours, at least 16 hours, at least 17 hours, at least 18 hours, at least 19 hours, at least 20 hours, at least 21 hours, at least 22 hours, at least 23 hours, at least 24 hours, at least 36 hours, at least 48 hours, at least 60 hours, at least 72 hours, or at least 96 hours prior to performing the medical procedure.

Alternatively or in combination, the present disclosure includes methods for inducing a protective response in order to treat an injury or insult associated with a medical procedure that has already been performed on the subject. For example, in certain embodiments, the composition or the pharmaceutical composition is administered at least 1 hour, at least 2 hours, at least 3 hours, at least 4 hours, at least 5 hours, at least 6 hours, at least 7 hours, at least 8 hours, at least 9 hours, at least 10 hours, at least 11 hours, at least 12 hours, at least 13 hours, at least 14 hours, at least 15 hours, at least 16 hours, at least 17 hours, at least 18 hours, at least 19 hours, at least 20 hours, at least 21 hours, at least 22 hours, at least 23 hours, at least 24 hours, at least 36 hours, at least 48 hours, at least 60 hours, at least 72 hours, or at least 96 hours after performing the medical procedure.

In some embodiments, homing of a peptide of this disclosure to the kidneys can be assessed in an animal model such as those described in Zager et al. (Am J Physiol Renal Physiol. 2016 Sep. 1; 311(3):F640-51), Zager et al. (Kidney Int. 2013 Oct.; 84(4):703-12), Zager et al. (Transl Res. 2015 Nov.; 166(5):485-501), Bremlage et al. (BMC Nephrol. 2010 Nov. 16; 11:31), Zager et al. (Am J Physiol Renal Physiol. 2011 Dec.; 301(6):F1334-45), and Mullins et al. (Dis Model Mech. 2016 Dec. 1; 9(12):1419-1433), all of which are incorporated herein by reference.

Multiple peptides or peptide conjugates described herein can be administered in any order or simultaneously. In some cases, multiple functional fragments of peptides derived from toxins or venom, or such fragments conjugated to active agents, can be administered in any order or simultaneously. If simultaneously, the multiple peptides or peptide conjugates described herein can be provided in a single, unified form, such as an intravenous injection, or in multiple forms, such as subsequent intravenous dosages.

Peptides, peptide-conjugates, and/or pharmaceutical compositions can be packaged as a kit. In some embodiments, a kit includes written instructions on the use or administration of the peptides, peptide-conjugates, and/or pharmaceutical compositions, in accordance with the various methods described herein.

EXAMPLES

The following examples are included to further describe some embodiments of the present disclosure, and should not be used to limit the scope of the disclosure.

Example 1 Manufacture of Peptides

The peptide sequence was reverse-translated into DNA, synthesized, and cloned in-frame with siderocalin using standard molecular biology techniques. (M. R. Green, Joseph Sambrook. Molecular Cloning. 2012 Cold Spring Harbor Press.). The resulting construct was packaged into a lentivirus, transfected into HEK293 cells, expanded, isolated by immobilized metal affinity chromatography (IMAC), cleaved with tobacco etch virus protease, and purified to homogeneity by reverse-phase chromatography. Following purification, each peptide was lyophilized and stored frozen.

Example 2 Radiolabeling of Peptide

This example describes radiolabeling of peptides with standard techniques. See J Biol Chem. 254(11):4359-65 (1979). The sequences were engineered to have the amino acids, “G” and “S” at the N terminus. See Methods in Enzymology V91:1983 p.570 and Journal of Biological Chemistry 254(11):1979 p. 4359. An excess of formaldehyde was used to ensure complete methylation (dimethylation of every free amine). The labeled peptides were isolated via solid-phase extraction on Strata-X columns (Phenomenex 8B-S100-AAK), rinsed with water with 5% methanol, and recovered in methanol with 2% formic acid. Solvent was subsequently removed in a blowdown evaporator with gentle heat and a stream of nitrogen gas.

Example 3 Peptide Detectable Agent Conjugates

This example describes the dye labeling of peptides. A peptide of the disclosure is expressed recombinantly or chemically synthesized, and then the N-terminus of the peptide is conjugated to an detectable agent via an NHS ester using DCC or EDC to produce a peptide-detectable agent conjugate. The detectable agent is the fluorophore dye is a cyanine dye, such as Cy5.5 or an Alexa fluorophore, such as Alexa647.

The peptide detectable agent conjugates are administered to a subject. The subject can be a human or a non-human animal. After administration, the peptide detectable agent conjugates accumulate in the kidney. The subject, or a biopsy from the subject, can be imaged to visualize localization of the peptide detectable agent conjugates to kidney. In some aspects, visualization of the peptide detectable agent conjugates in kidney after administration results in diagnosis of kidney damage or any kidney disorder.

Example 4 Peptide Accumulation in Kidneys

This example illustrates peptide accumulation in kidneys in animals with intact kidneys. A peptide of this disclosure was radiolabeled by methylating lysines and the N-terinus, so the actual binding agent contained methyl or dimethyl lysine(s) and a methylated or dimethylated amino terminus. A target dosage of 100 nmol of each peptide carrying 10-25 μCi of 14C was administered to Female Harlan athymic nude mice by a tail vein injection. Each peptide was allowed to freely circulate within the animal for either 4 hours or 24 hours before the animals are euthanized and sectioned. Mice were frozen in a hexane/dry ice bath and then frozen in a block of carboxymethylcellulose. Whole animal sagittal slices were prepared that result in thin frozen sections being available for imaging. Thin, frozen sections of animal including imaging of tissues such as brain, tumor, liver, kidney, lung, heart, spleen, pancreas, muscle, adipose, gall bladder, upper gastrointestinal track, lower gastrointestinal track, bone, bone marrow, reproductive track, eye, cartilage, stomach, skin, spinal cord, bladder, salivary gland, and other types of tissues were obtained with a microtome, allowed to desiccate in a freezer, and exposed to phosphoimager plates for about ten days.

These plates were developed. A signal in tissue darker than the signal expected from blood in that tissue indicated peptide accumulation in a region, tissue, structure or cell. High signal in the kidneys indicated presence and accumulation of the peptide in the kidneys.

Example 5 Peptide Homing with Therapeutic Agents

This example describes certain exemplary therapeutic agents that are conjugated to a peptide. A peptide of the disclosure is expressed recombinantly or chemically synthesized and then is conjugated to an exemplary drug, such as paclitaxel or triamcinolone acetonide or budesonide using techniques known in the art, such as those described in Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013). One or more drugs is conjugated per peptide, or an average of less than one drug is conjugated per peptide.

Coupling of these drugs to a peptide of any of SEQ ID NO: 132, SEQ ID NO: 33; SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 569, or SEQ ID NO: 570 targets the drug to the kidney of the subject. One or more drug-peptide conjugates are administered to a human or animal. The resulting peptide or peptide conjugate is administered to a non-human animal subcutaneously, intravenously, or orally, or is injected directly into kidney intra-articularly. Biodistribution can be assessed by LC/MS, autoradiography, positron emission tomography (PET), or fluorescence imaging. A peptide or peptide conjugate is homed to kidney.

Any one of these drug-peptide conjugates is used to control pain and inflammation associated with any kidney disorder described herein. Upon administration and homing of peptide-drug conjugates, the kidney-related pain or inflammation condition is alleviated.

Example 6 Peptide Homing to Kidney in Non-Human Animals

This example illustrates a peptide or peptide conjugate of this disclosure homing to kidney in non-human animals. Non-human animals include but are not limited to guinea pigs, rabbits, dog, cats, horses, rats, mice, cows, pigs, non-human primates, and other non-human animals. A peptide of the present disclosure is recombinantly expressed or chemically synthesized and is used directly, after radiolabeling, or after conjugation to a fluorophore or therapeutic compound. The peptide is selected from any one of the peptides of SEQ ID NO: 132, SEQ ID NO: 33; SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 569, or SEQ ID NO: 570. The resulting peptide or peptide conjugate is administered to a non-human animal subcutaneously, intravenously, or orally, or is injected directly into kidney intra-articularly. Biodistribution is assessed by LC/MS, autoradiography, positron emission tomography (PET), or fluorescence imaging. A peptide or peptide conjugate is homed to kidney in non-human animals.

Example 7 Whole Body Fluorescence and Isolated Kidney Fluorescence of Homing Peptides

This example illustrates whole body fluorescence and isolated kidney fluorescence of peptide homers of this disclosure. Any peptide of the present disclosure is chemically conjugated to one molecule of a near infrared fluorophore, at the N-terminus of the peptide via an active NHS ester on the dye. A dose of 10 nmol of each peptide conjugated to a fluorophore is administered to Female Harlan athymic nude mice, weighing 20-25 g, and is administered via tail vein injection. Each experiment is done at least in duplicate (n=2 mice per group). The peptide fluorophore conjugate is allowed to freely circulate for the described time period before the mice were euthanized at various time points. Mice are evaluated for peptide distribution of the peptide fluorescence in whole body imaging and in isolated kidney imaging.

For whole body fluorescence (WBF), at the end of the dosing period, mice are frozen in a hexane/dry ice bath and then embedded in a frozen block of carboxymethylcellulose. Whole animal sagittal slices are prepared that result in thin frozen sections for imaging. Thin frozen sections are obtained using a microtome and allow visualization of tissues. Sections are allowed to dessicate in a freezer prior to imaging. WBF is performed on fluorescent sections, which are scanned on a Li-Cor Odyssey scanner at a setting of 169 μm resolution, medium quality, 700 channel, L-2.0 intensity.

For isolated kidney fluorescence studies, mice are euthanized by CO₂ asphyxiation at the end of the dosing period. The kidney is removed and imaged on a Sepctrum IVIS imager (ex/em: 675 nm. 720 nm) with a 1 second exposure length and a focal height of 0.5 cm.

Example 8 Whole Body Autoradiography of Homing Peptides

This example illustrates whole body autoradiography of peptide homers of this disclosure. Peptides are radiolabeled by methylating lysines at the N-terminus as described in EXAMPLE 2. As such, the peptide may contain methyl or dimethyl lysines and a methylated or dimethlyated amino terminus. A dose of 100 nmol radiolabeled peptide is administered via tail vein injection in Female Harlan athymic nude mice, weighing 20-25 g. The experiment is done in at least duplicate (n=2 animals per group). Each radiolabeled peptide is allowed to freely circulate within the animal for the described time period before the animals were euthanized and sectioned.

Whole body autoradiography (WBA) sagittal sectioning is performed as follows. At the end of the dosing period, mice are frozen in a hexane/dry ice bath and then embedded in a frozen block of carboxymethylcellulose. Whole animal sagittal slices are prepared that result in thin frozen sections for imaging. Thin frozen sections are obtained using a microtome and allow visualization of tissues such as brain, tumor, liver, kidney, lung, heart, spleen, pancreas, muscle, adipose, gall bladder, upper gastrointestinal tract, lower gastrointestinal tract, bone, bone marrow, reproductive tract, eye, cartilage, stomach, skin, spinal cord, bladder, salivary gland, and more. Sections are allowed to dessicate in a freezer prior to imaging.

For the autoradiography imaging, tape mounted thin sections are freeze dried and radioactive samples are exposed to phosphoimager plates for 7 days. These plates are developed and the signal (densitometry) from each organ is normalized to the signal found in the cardiac blood of each animal. A signal in tissue darker than the signal expected from blood in that tissue indicates accumulation in a region, tissue, structure, or cell.

Example 9 Peptide Localization in Kidney Extracellular Matrix

This example illustrates localization of peptides of this disclosure in kidney extracellular matrix. In one embodiment, animals are dosed and are processed as described in EXAMPLE 13 and EXAMPLE 14 in animals with intact kidneys. At the end of the dosing period, animals are euthanized and kidney is optionally removed for use in staining and imaging procedures. Whole animal sagittal slices are prepared that result in thin frozen sections being available for staining and imaging. Thin frozen sections or live kidney explants are acquired, stained, and visualized. Whole animal sagittal slices are prepared that result in thin frozen sections being available for staining and imaging. One or more kidney components are identified in thin frozen sections or live kidney explants using standard staining techniques: collagen fibrils, glycosaminoglycans, or other aspect of the extracellular matrix. A peptide of this disclosure is found to localize to a structure in the kidney, localized intracellularly or extracellularly bound, or both. Localization is visualized and confirmed by microscopy.

. A peptide of the present disclosure is found to localize to the extracellular matrix in kidney. The peptide is selected from any one of the peptides of SEQ ID NO: 132, SEQ ID NO: 33; SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. The peptide may be bound to one or more components of the extracellular matrix, such as proteoglycans, glycosaminoglycans, aggrecan, decorin, or collagen, collagen type I, II, III, V, VI, VII and XV, both sulphated and non-sulphated glycosaminoglycans, glycoproteins and polysaccarides. Localization is visualized and confirmed by microscopy.

In another embodiment, peptides or peptide-drug conjugates of this disclosure are administered in humans and are localized in kidney extracellular matrix. Kidney fibrosis, focal sclerosis, crescentic glomerulonephritis, and membranoproliferative glomerulonephritis can be diagnosed and treated.

Example 10 Peptide Binding to Kidney Explants

This example illustrates a peptide or peptide conjugation of this disclosure homing, targeting, being directed to, migrating to, being retained by, accumulating in, or binding to human and animal kidney explants in culture. The peptide is selected from any one of the peptides of SEQ ID NO: 132, SEQ ID NO: 33; SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Peptides are recombinantly expressed or chemically synthesized and are used directly, after radiolabeling, or after conjugation to a fluorophore or therapeutic compound. A peptide of peptide conjugate of this disclosure is incubated with kidney explants derived from humans or animals. Peptides of peptide conjugate are found to bind to kidney explants. The interaction with kidney is confirmed using various methods that include but are not limited to liquid scintillation counting, confocal microscopy, immunohistochemistry, HPLC, or LC/MS. The peptide shows a higher level of signal than a control peptide that is administered that is not a kidney binding peptide.

Example 11 Effects of Peptide on Ion Channels

This example describes the interaction between peptides of the present disclosure and ion channels. Ion channels can be associated with pain and can be activated in disease states in the kidney, including variations in ion channels that cause disease or modulation of ion channels in order to treat diseases (Kuo et al. Chem Rev. 2012 Dec. 12;112(12):6353-72). A peptide of the disclosure is expressed and administered in a pharmaceutical composition to a patient to treat a kidney condition or disease associated with an ion channel and treatable by binding, blocking, or interacting with the ion channel. Ion channels, such as Nav 1.7, are inhibited by peptides of the present disclosure. A given peptide is expressed recombinantly or chemically synthesized, wherein the peptide selected from SEQ ID NO: 132, SEQ ID NO: 33; SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Following expression or synthesis, the peptide is used directly or conjugated to a therapeutic compound, such as those described herein. A peptide of the present disclosure selectively interacts with ion channels, or is mutated in order to interact with ion channels. For example, a peptide of this disclosure modulates TRPC6 or TRPM6. When the peptide is administered to a human subject, kidney TRPC6 function is modulated, Ca²⁺ influx is more normalized and focal segmental glomerulosclerosis is treated. Morover, a peptide of this disclosure is bound to Nav 1. 7 by a peptide of this disclosure or Nav 1. 7 is blocked by a peptide of this disclosure. When the peptide is administered to a human subject, Nav 1.7 signaling is reduced in the tissues in or in proximity to the kidney and pain relief is thereby provided.

Example 12 Peptide-Fc Protein Fusions

This example illustrates making and using peptide-Fc protein fusions. A peptide of SEQ ID NO: 132 was recombinantly expressed with the sequence for the human IgG1 Fc protein in HEK293 cells to yield a sequence of SEQ ID NO: 575

(METDTLLLWVLLLWVPGSTGGSGVPINVRCRGSRDCLDPCRRAGMRFGR CINSRCHCTPGGSGGSDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMIS RTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVS VLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPS RDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSF FLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK)

The sequence of any peptide of this disclosure is expressed as a fusion protein with either murine or human Fc by adding a secretion signal sequence to the N-terminus and an Fc sequence to the C-terminus. This creates a bivalent molecule with improved secretion properties. The larger peptide-Fc fusion is expressed in different mammalian or insect cell lines and is useful as a research reagent and a therapeutic.

Fc fusion to a peptide of SEQ ID NO: 132 to yield a sequence of SEQ ID NO: 575 extends half-life and improves biodistribution of the peptide to the kidney. Any peptide of this disclosure is co-expressed with Fc protein to yield Fc-fusion peptides with longer half-life and improved homing to kidney. In SEQ ID NO: 575, the secretion signal sequence METDTLLLWVLLLWVPGSTG (SEQ ID NO: 576) is followed by the peptide of SEQ ID NO: 132, and is followed by the sequence for Fc protein. Cleaving can be imprecise, resulting in cleavage at position 20 or position 21 of SEQ ID NO: 575.

Example 13 Peptide Conjugate Hydrolysis

This example describes preparation of peptide conjugates having tunable hydrolysis rates. The peptide-drug conjugates described below are synthesized with the modification that instead of using succinic anhydride, other molecules are used to provide steric hindrance to hydrolysis or an altered local environment at the carbon adjacent to the final hydrolyzable ester. In one exemplary conjugate, the peptide-drug conjugate is synthesized with tetramethyl succinic anhydride to generate hindered esters, which causes a decreased rate of hydrolysis. In another exemplary conjugate, one methyl group is present at the adjacent carbon. In another exemplary conjugate, two methyl groups are present at the adjacent carbon. In another exemplary conjugate, one ethyl group is present at the adjacent carbon. In another exemplary conjugate, two ethyl groups are present at the adjacent carbon. In another exemplary conjugate, the carbon linker length is increased such as by using glutaric anhydride instead of succinic anhydride, increasing the local hydrophobicity and lowering the hydrolysis rate. In another exemplary conjugate, a hydroxyl group is located on the adjacent carbon, increasing the local hydrophilicity and increasing the hydrolysis rate. The rate of hydrolysis in these exemplary conjugates is therefore adjusted, preventing premature cleavage and ensuring that the majority of peptide-dexamethasone conjugates accumulate in kidney prior to release of the drug by hydrolysis but that the dexamethasone is also released in the kidney in a timely manner.

The resulting peptide conjugates are administered to a human or animal subcutaneously, intravenously, orally, or injected directly into the kidney to treat disease.

Example 14 Peptide Conjugates with Stable Linkers

This example describes preparation of peptide conjugates with stable linkers. A peptide of the disclosure (e.g., SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570) is expressed recombinantly or chemically synthesized. The peptide is conjugated to a detectable agent or an active agent via a stable linker, such as an amide linkage or a carbamate linkage. The peptide is conjugated to a detectable agent or an active agent via a stable linker, such as an amide bond using standard 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC) or dicylcohexylcarbodiimide (DCC) based chemistry or thionyl chloride or phosphorous chloride-based bioconjugation chemistries.

A peptide and drug conjugated via a linker are described with the formula Peptide-A-B-C-Drug, wherein the linker is A-B-C. A can be a stable amide link such as that formed by reacting an amine on the peptide with a linker containing a tetrafluorophenyl (TFP) ester or an NHS ester. A can also be a stable carbamate linker such as that formed by reacting an amine on the peptide with an imidazole carbamate active intermediate formed by reaction of CDI with a hydroxyl on the linker. A can also be a stable secondary amine linkage such as that formed by reductive alkylation of the amine on the peptide with an aldehyde or ketone group on the linker. A can also be a stable thioether linker formed using a maleimide or bromoacetamide in the linker with a thiol in the peptide, a triazole linker, a stable oxime linker, or a oxacarboline linker. B is (—CH2—)_(x)— or a short PEG (—CH₂CH₂O—)_(x) (x is 0-20). Alternatively, spacers within the linker is optional and is included or not at all. C is an amide bond formed with an amine or a carboxylic acid on the drug, a thioether formed between a maleimide on the linker and a sulfhydroyl on the drug, a secondary or tertiary amine, a carbamate, or other stable bonds. Any linker chemistry described in “Current ADC Linker Chemistry,” Jain et al., Pharm Res, 2015 DOI 10.1007/s11095-015-1657-7 can be used.

The resulting peptide conjugates are administered to a human or animal subcutaneously, intravenously, orally, or injected directly into the kidney to treat disease. The peptide is not specifically cleaved from the detectable agent or active agent via a targeted mechanism. The peptide can be degraded by mechanisms such as catabolism, releasing a drug that is modified or not modified form its native form (Singh, Luisi, and Pak. Pharm Res 32:3541-3571 (2015)). The peptide drug conjugate exerts its pharmacological activity while still intact, or while partially or fully degraded, metabolized, or catabolized.

Example 15 Peptide Conjugates with Cleavable Linkers

This example describes preparation of peptide conjugates having cleavable linkers. The peptide is selected from any one of peptides of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. A peptide of the disclosure is expressed recombinantly or chemically synthesized. A peptide and drug are conjugated via a linker and is described with the formula Peptide-A-B-C-Drug, wherein the linker is A-B-C. A is a stable amide link such as that formed by reacting an amine on the peptide with a linker containing a tetrafluorophenyl (TFP) ester or an NHS ester. A can also be a stable carbamate linker such as that formed by reacting an amine on the peptide with an imidazole carbamate active intermediate formed by reaction of CDI with a hydroxyl on the linker. A can also be a stable secondary amine linkage such as that formed by reductive alkylation of the amine on the peptide with an aldehyde or ketone group on the linker. A can also be a stable thioether linker formed using a maleimide or bromoacetamide in the linker with a thiol in the peptide, a triazole linker, a stable oxime linker, or a oxacarboline linker. B is (—CH2—)_(x)— or a short PEG (—CH₂CH₂O—)_(x) (x is 0-20) or other spacers or no spacer. C is an ester bond to the hydroxyl or carboxylic acid on the drug, or a carbonate, hydrazone, or acylhydrazone, designed for hydrolytic cleavage. The hydrolytic rate of cleavage is varied by varying the local environment around the ester, including carbon length (—CH2—)_(x), steric hindrance (including adjacent side groups such as methyl, ethyl, cyclic), hydrophilicity or hydrophobicity. Hydrolysis rate is affected by local pH, such as lower pH in certain compartments of the body or of the cell such as endosomes and lysosomes or diseased tissues. C is a pH sensitive group such as a hydrazone or oxime linkage. Alternatively C is a disulfide bond designed to be released by reduction, such as by glutathione. Alternatively C (or A-B-C) is a peptidic linkage design for cleavabe by enzymes. Optionally, a self-immolating group such as pABC is included to cause release of a free unmodified drug upon cleavage (Antibody-Drug Conjugates: Design, Formulation, and Physicochemical Stability, Singh, Luisi, and Pak. Pharm Res (2015) 32:3541-3571). The linker is cleaved by enzymes such as esterases, matrix metalloproteinases, cathepsins such as cathepsin B, glucuronidases, a protease, or thrombin. Alternatively, the bond designed for cleavage is at A, rather than C, and C could be a stable bond or a cleavable bond. An alternative design is to have stable linkers (such as amide or carbamate) at A and C and have a cleavable linker in B, such as a disulfide bond. The rate of reduction is modulated by local effects such as steric hindrance from methyl or ethyl groups or modulating hydrophobicity/hydrophilicity.

The resulting peptide conjugates are administered to a human or animal subcutaneously, intravenously, orally, or injected directly into the kidney to treat disease.

Example 16 Acetylsalicylic Acid Peptide Conjugate

This example describes the conjugation of acetylsalicylic acid to a peptide using a lactic acid linker. A conjugate is produced from a mixture of (R,S)-acetylsalicylic acid, lactic acid, and a peptide.

The acetylsalicylic acid-lactic acid linker conjugate depicted above is then reacted with a lysine or the N-terminus of a cystine-dense peptide to create a acetylsalicylic acid-lactic acid-peptide conjugate. The cystine-dense peptide is selected from the peptides of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570.

Acetylsalicylic acid is currently dosed as an enantiomeric mixture, in which enantiomers with a single racemic stereocenter are very difficult to separate. As in the reaction scheme (I), a diastereomer with two chiral centers is created by the addition of a chiral linker such as L-lactic acid. Since diastereomers are easily separated, the active enantiomer of acetylsalicylic acid conjugated to the lactic acid linker can be purified prior to conjugation to a peptide. The chemical synthesis can use any conjugation techniques known in the art, such as described in Bioconjugate Techniques by Greg Hermanson and in “Ketorolac-dextran conjugates: synthesis, in vitro, and in vivo evaluation:” Acta Pharm. 57 (2007) 441-450, Vyas, Trivedi, and Chaturvedi. The conjugate can display anti-inflammatory activity, or free acetylsalicylic acid is released from the conjugate to provide anti-inflammatory activity. The free acetylsalicylic acid can result from hydrolysis that occurs after administration, such as hydrolysis at the ester bond. By dosing the conjugate containing the kidney homing peptide, a higher AUC of acetylsalicylic acid delivery to the kidney may be achieved than would be achieved by systemic dosing of acetylsalicylic acid alone.

Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Any one of these drug-peptide conjugates is used to control pain and inflammation associated with any kidney disorder described herein. Upon administration and homing of peptide-acetylsalicyclic acid conjugates, the kidney-related pain or inflammation condition is alleviated.

Example 17 Acetylsalicylic Acid Peptide Conjugate

This example describes the conjugation of acetylsalicylic acid to a peptide using a PEG linker. A conjugate is produced using acetylsalicylic acid and a PEG linker, which forms an ester bond that can hydrolyze as described in “In vitro and in vivo study of poly(ethylene glycol) conjugated ibuprofen to extend the duration of action,” Scientia Pharmaceutica, 2011, 79:359-373, Nayak and Jain. Fischer esterification is used to conjugate ibuprofen with a short PEG, e.g., with triethylene glycol, to yield ibuprofen-ester-PEG-OH.

Following preparation of the PEG-ibuprofen conjugate as shown above, the hydroxyl moiety of PEG is activated with N,N′-disuccinimidyl carbonate (DSC) to form ibuprofen-ester-PEG-succinimidyl carbonate, which is then reacted with a lysine or the N-terminus of a cystine-dense peptide to form an ibuprofen-ester-PEG-peptide conjugate. The cystine-dense peptide is selected from any one of the peptides of sequence SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. The conjugate can display anti-inflammatory activity, or free ibuprofen is released from the conjugate to provide anti-inflammatory activity. The free ibuprofen can result from hydrolysis that occurs after administration, such as hydrolysis at the ester bond.

Ibuprofen-peptide conjugates are administered to a subject in need thereof. The subject can be a human or a non-human animal.

Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Any one of these drug-peptide conjugates is used to control pain and inflammation associated with any kidney disorder described herein. Upon administration and homing of peptide-acetylsalicyclic acid conjugates, the kidney-related pain or inflammation condition is alleviated.

Example 18 Dexamethasone Peptide Conjugate

This example describes different methods of conjugating dexamethasone with a peptide of this disclosure. A peptide of SEQ ID NO: 132, SEQ ID NO: 33, or SEQ ID NO: 196 is recombinantly expressed. Dexamethasone is readily conjugated to a peptide of this disclosure using a dicarboxylic acid linker. The peptide-dexamethasone conjugate is made by first converting dexamethasone to a hemisuccinate by reacting it with succinic anhydride. The hemisuccinate is then converted to a succinate carboxylic acid containing an active ester, using dicyclohexyl carbodiimide (DCC) or 1-ethyl-3-(3-dimethylamninopropyl)carbodiimide (EDC) in the presence of N-hydroxy succinimide (NETS). This active ester is then reacted with a lysine or the N-terminus of a cystine-dense peptide to create a dexamethasone-carboxylic acid-peptide conjugate. Methods such as those described in “Functionalized derivatives of hyaluronic acid oligosaccharides: drug carriers and novel biomaterials” Bioconjugate Chemistry 1994, 5, 339-347, Pouyani and Prestwich, and Bioconjugate Techniques by Greg Hermanson can be used.

Peptide-dexamethasone conjugates are prepared by coupling dexamethasone to the peptides of this disclosure using standard coupling-reagent chemistry. For example, dexamethasone conjugates are made by reacting dexamethasone hemigluterate with 1.05 molar equivalents of 1,1′-carbonyldiimidazole in anhydrous DMSO in an inert atmosphere. After 30 minutes, excess dexamethasone in anhydrous DMSO is added along with two molar equivalents of anhydrous trimethylamine. The N-hydroxysuccinimide ester of the peptide-dexamethasone conjugate is generated to form a shelf-stable intermediate for later reaction with an amine-containing carrier. The N-terminal dexamethasone-peptide conjugate (SEQ ID NO: 132B) is verified by electrospray mass spectrometry (ES-MS) within a 10 ppm error.

A peptide of any of the sequences of this disclosure including SEQ ID NO: 132, SEQ ID NO: 33; SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570, are conjugated to dexamethasone using the methods described above.

Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 19 Beclomethasone monopropionate Peptide Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 45 or SEQ ID NO: 132 of this disclosure to beclomethasone monopropionate. Beclomethasone monopropionate is readily conjugated to any peptide disclosed herein via a dicarboxylic acid linker. The dicarboxylic acid linker is a linear dicarboxylic acid, such as succinic acid, or a related cyclic anhydride, such as succinic anhydride. Reactions with anhydrides can proceed under simple conditions. For example, the reaction of beclomethasone monopropionate with five molar equivalents of glutaric anhydride is carried out in anhydrous pyridine at room temperature. Reactions with dicarboxylic acids can occur using standard carbodiimide coupling methods. For example, beclomethasone monopropionate is reacted with one molar equivalent dimethyl succinic acid, one molar equivalent 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (or another carbodiimide), and 0.2 molar equivalents of 40-dimethylamino pyridine.

The same methods as described in EXAMPLE 13 are used to adjust the rate of hydrolysis of peptide-beclomethasone monopropionate conjugates, preventing premature cleavage and ensuring that the beclomethasone monopropionate of peptide-beclomethasone monopropionate conjugates accumulate in kidney.

Peptide-beclomethasone monopropionate conjugates are prepared by coupling beclomethasone monopropionate to the peptides of this disclosure using standard coupling-reagent chemistry. The peptide-beclomethasone monopropionate conjugate was made by first converting beclomethasone monopropionate to a hemisuccinate by reacting it with succinic anhydride. The hemisuccinate was then converted to a succinate carboxylic acid containing an active ester, using dicyclohexyl carbodiimide (DCC) or 1-ethyl-3-(3-dimethylamninopropyl)carbodiimide (EDC) in the presence of N-hydroxy succinimide (NETS). This active ester was then reacted with a lysine or the N-terminus of a peptide to create a beclomethasone monopropionate -carboxylic acid-peptide conjugate. Methods such as those described in “Functionalized derivatives of hyaluronic acid oligosaccharides: drug carriers and novel biomaterials” Bioconjugate Chemistry 1994, 5, 339-347, Pouyani and Prestwich, and Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013) can be used.

Peptide-beclomethasone monopropionate conjugates were prepared by coupling beclomethasone monopropionate to the peptides of this disclosure using standard coupling-reagent chemistry. For example, beclomethasone monopropionate conjugates were made by reacting beclomethasone monopropionate hemigluterate with 1.05 molar equivalents of 1,1′-carbonyldiimidazole in anhydrous DMSO in an inert atmosphere. After 30 minutes, excess beclomethasone monopropionate in anhydrous DMSO was added along with two molar equivalents of anhydrous trimethylamine. The N-hydroxysuccinimide ester of the peptide-beclomethasone monopropionate conjugate was generated to form a shelf-stable intermediate for later reaction with an amine-containing carrier.

Beclomethasone monopropionate is also readily conjugated to any peptide disclosed herein via a dicarboxylic acid linker. The dicarboxylic acid linker is a linear dicarboxylic acid, such as succinic acid, or a related cyclic anhydride, such as succinic anhydride. Reactions with anhydrides can proceed under simple conditions. For example, the reaction of beclomethasone monopropionate with five molar equivalents of glutaric anhydride is carried out in anhydrous pyridine at room temperature. Reactions with dicarboxylic acids can occur using standard carbodiimide coupling methods. For example, beclomethasone monopropionate is reacted with one molar equivalent dimethylsuccinic acid, one molar equivalent 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (or another carbodiimide), and 0.2 molar equivalents of 40-dimethylamino pyridine. The peptide-beclomethasone monopropionate conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidneys. The subject is a human or animal and has inflammation in the kidney tissues. Upon administration of the peptide-beclomethasone monopropionate conjugates, the kidney inflammation is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33; SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570.

Such peptide-drug conjugates are made using either a cleavable or stable linker as described herein (e.g. EXAMPLES 14 and 15).

Example 20 Desciclesonide Peptide Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 132, SEQ ID NO: 33, or SEQ ID NO: 196 of this disclosure to desciclesonide. Ciclesonide is a prodrug that is metabolized in vivo to the active metabolite desciclesonide. By conjugating desciclesonide to a peptide via an ester linker, upon hydrolysis the released drug would be desciclesonide, just as after systemic administration of ciclesonide the active metabolite desciclesonide is present and active. Desciclesonide is readily conjugated to any peptide disclosed herein via a dicarboxylic acid linker. The dicarboxylic acid linker is a linear dicarboxylic acid, such as succinic acid, or a related cyclic anhydride, such as succinic anhydride. Reactions with anhydrides can proceed under simple conditions. For example, the reaction of desciclesonide with five molar equivalents of glutaric anhydride is carried out in anhydrous pyridine at room temperature. Reactions with dicarboxylic acids can occur using standard carbodiimide coupling methods. For example, desciclesonide is reacted with one molar equivalent dimethylsuccinic acid, one molar equivalent 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (or another carbodiimide), and 0.2 molar equivalents of 40-dimethyl amino pyridine.

The same methods as described in EXAMPLE 13 are used to adjust the rate of hydrolysis of peptide-desciclesonide conjugates, preventing premature cleavage and ensuring that the desciclesonide of peptide-desciclesonide conjugates accumulate in kidney.

Desciclesonide is also readily conjugated to any peptide disclosed herein via a dicarboxylic acid linker. The dicarboxylic acid linker is a linear dicarboxylic acid, such as succinic acid, or a related cyclic anhydride, such as succinic anhydride. Reactions with anhydrides can proceed under simple conditions. For example, the reaction of desciclesonide with five molar equivalents of glutaric anhydride is carried out in anhydrous pyridine at room temperature. Reactions with dicarboxylic acids can occur using standard carbodiimide coupling methods. For example, desciclesonide is reacted with one molar equivalent dimethylsuccinic acid, one molar equivalent 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (or another carbodiimide), and 0.2 molar equivalents of 40-dimethylamino pyridine

The peptide-desciclesonide conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidneys. The subject is a human or animal and has inflammation in the kidney tissues. Upon administration of the peptide-desciclesonide conjugates, the kidney inflammation is alleviated.

The peptide-desciclesonide conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidneys. The subject is a human or animal and has inflammation in the kidney tissues. Upon administration of the peptide-desciclesonide conjugates, the kidney inflammation is alleviated.

The peptide can also be a peptide of SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570.

Such peptide-drug conjugates are made using either a cleavable or stable linker as described herein (e.g. EXAMPLES 14 and 15).

Example 21 Peptide-Tofacitinib Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 33 this disclosure to Tofacitinib (generic name of Xeljanz). Tofacitinib is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013). From one to eight peptides are linked to Xeljanz.

The peptide-tofacitinib conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidney. The subject is a human or animal and is undergoing kidney transplantation. Upon administration and homing of peptide-tofacitinib conjugates, the immune response that could lead to rejection of the kidney transplant is reduced.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 22 Peptide-Ustekinumab Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 33 this disclosure to ustekinumab. Ustekinimab is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) edition, 2013). Alternatively the peptide-active agent of this Example can be expressed as a fusion protein. From one to eight peptides are linked to ustekinumab.

The peptide-ustekinumab conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidney. The subject is a human or animal and is undergoing kidney transplantation. Upon administration of the peptide-ustekinumab conjugates, the immune response that could lead to rejection of the kidney transplant is reduced or alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 23 Peptide-IL-17 Inhibitor Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 4 this disclosure to an IL-17 inhibitor. An IL-17 inhibitor is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013).

The peptide-IL-17 inhibitor conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidney. The subject is a human or animal and has acute kidney injury such as that which can be caused by treatment with cisplatin (Am J Pathol. 2014 May; 184(5):1411-8. Innate IL-17A-producing leukocytes promote acute kidney injury via inflammasome and Toll-like receptor activation.). Upon administration and homing of peptide-IL-17 inhibitor conjugates, the ankylosing spondylitis condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 24 Peptide-Iguratimod Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 41 this disclosure to iguratimod. Iguratimod is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013).

The peptide-iguratimod conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidneys. The subject is a human or animal and has refractory lupus nephritis. Upon administration and homing of peptide-iguratimod conjugates, the refractory lupus nephritis condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 25 Peptide Mycophenolic Acid Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 5 this disclosure to mycophenolic acid. Mycophenolic acid is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013).

The peptide-mycophenolic acid conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidneys. The subject is a human or animal and has organ transplantation, infection, cancer, or other kidney disorders. Upon administration and homing of peptide-mycophenolic acid conjugates, the organ transplantation, infection, cancer, other kidney disorders condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 26 Peptide-Tacrolimus Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 6 this disclosure to tacrolimus. Tacrolimus is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013).

The peptide-tacrolimusconjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidneys. The subject is a human or animal and has organ transplantation, any other kidney disease. Upon administration and homing of peptide-tacrolimus conjugates, the organ transplantation, any other kidney disease condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, or SEQ ID NO: 5, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 27 Peptide-Secukinumab Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 132, SEQ ID NO: 4, or SEQ ID NO: 33 to secukinumab. Secukinumab is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) edition, 2013). From one to eight peptides are linked to secukinumab. Alternatively the peptide-active agent of this Example can be expressed as a fusion protein.

The peptide-secukinumab conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidney. The subject is a human or animal and has ankylosing spondylitis. Upon administration and homing of peptide-secukinumab acid conjugates, the ankylosing spondylitis condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, or SEQ ID NO: 5, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 28 Peptide-Sirukumab Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 132, SEQ ID NO: 4, or SEQ ID NO: 33 to sirukumab. Sirukumab is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) edition, 2013). From one to eight peptides are linked to sirukumab. Alternatively the peptide-active agent of this Example can be expressed as a fusion protein.

The peptide-sirukumab conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidneys. The subject is a human or animal and has rheumatoid arthritis, immune diseases of the kidneys. Upon administration and homing of peptide-sirukumab conjugates, the rheumatoid arthritis, immune diseases of the kidneys condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, or SEQ ID NO: 5, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 29 Peptide-Anifrolumab Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 132, SEQ ID NO: 4, or SEQ ID NO: 33 to anifrolumab. Anifrolumab is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) edition, 2013). From one to eight peptides are linked to anifrolumab. Alternatively the peptide-active agent of this Example can be expressed as a fusion protein.

The peptide-anifrolumab conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidneys. The subject is a human or animal and has lupus nephritis. Upon administration and homing of peptide-anifrolumab conjugates, the lupus nephritis condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, or SEQ ID NO: 5, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 30 Peptide-Denosumab Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 132, SEQ ID NO: 4, or SEQ ID NO: 33 to denosumab. Denosumab is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) edition, 2013). From one to eight peptides are linked to denosumab. Alternatively the peptide-active agent of this Example can be expressed as a fusion protein.

The peptide-denosumab conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidney. The subject is a human or animal and has osteoporosis. Upon administration and homing of peptide-denosumab conjugates, the osteoporosis condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, or SEQ ID NO: 5, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 31 Peptide-Rituximab Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 132, SEQ ID NO: 4, or SEQ ID NO: 33 to rituximab. Rituximab is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) edition, 2013). From one to eight peptides are linked to rituximab. Alternatively the peptide-active agent of this Example can be expressed as a fusion protein.

The peptide-rituximab conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidney. The subject is a human or animal and has rheumatoid arthritis, kidney transplant. Upon administration and homing of peptide-rituximab conjugates, the rheumatoid arthritis, kidney transplant condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, or SEQ ID NO: 5, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 32 Peptide-Omalizumab Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 132, SEQ ID NO: 4, or SEQ ID NO: 33 to omalizumab. Omalizumab is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) edition, 2013). From one to eight peptides are linked to omalizumab. Alternatively the peptide-active agent of this Example can be expressed as a fusion protein.

The peptide-omalizumab conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidneys. The subject is a human or animal and has kidney inflammation. Upon administration and homing of peptide-omalizumab conjugates, the kidney inflammation condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, or SEQ ID NO: 5, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 33 Peptide-Abatacept Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 132 to abatacept. Abatacept is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013).

The peptide-abatacept conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidneys. The subject is a human or animal and has lupus nephritis, organ transplant, focal segmental glomerulosclerosis. Upon administration and homing of peptide-abatacept conjugates, the lupus nephritis, organ transplant, focal segmental glomerulosclerosis condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 34 Peptide-Oxycodone Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 33 to oxycodone. Oxycodone is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013).

The peptide-oxycodone conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidney. The subject is a human or animal and has kidney-related pain. Upon administration and homing of peptide-oxycodone conjugates, the kidney-related pain condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 35 Peptide Caspaicin Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 4 to caspaicin. Caspaicin is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013).

The peptide-caspaicin conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidney. The subject is a human or animal and has kidney-related pain. Upon administration and homing of peptide-caspaicin conjugates, the kidney-related pain condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 36 Peptide-GSK2193874 Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 41 to GSK2193874. GSK2193874 is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013).

The peptide-GSK2193874 conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidney. The subject is a human or animal and has kidney-related pain. Upon administration and homing of peptide-GSK2193874 conjugates, the kidney-related pain condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 37 Peptide BIIB023 Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 5 this disclosure to BIIB023. BIIB023 is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013).

The peptide-BIIB023 conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidney. The subject is a human or animal and has lupus nephritis. Upon administration and homing of peptide-BIIB023 conjugates, the lupus nephritis condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 38 Peptide-Anakinra Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 6 to anakinra. Anakinra is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., Edition, 2013). From one to eight peptides are linked to anakinra. Alternatively the peptide-active agent of this Example can be expressed as a fusion protein.

The peptide-anakinra conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidney. The subject is a human or animal and has lupus nephritis. Upon administration and homing of peptide-anakinra conjugates, the lupus nephritis condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, or SEQ ID NO: 5, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 39 Peptide-IGF-1 Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 132 this disclosure to IGF-1. IGF-1 is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013). From one to eight peptides are linked to IGF-1. Alternatively the peptide-active agent of this Example can be expressed as a fusion protein.

The peptide-IGF-1 conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidney. The subject is a human or animal and has renal cancer. Upon administration and homing of peptide-IGF-1 conjugates, the renal cancer condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 40 Peptide-Romosozumab Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 132, SEQ ID NO: 4, or SEQ ID NO: 33 this disclosure to Romosozumab. Romosozumab is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) edition, 2013). From one to eight peptides are linked to romosozumab. Alternatively the peptide-active agent of this Example can be expressed as a fusion protein.

The peptide-romosozumab conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidney. The subject is a human or animal and has osteoporosis. Upon administration and homing of peptide-romosozumab conjugates, the osteoporosis condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 41 Peptide-ZVAD-fmk Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 33 this disclosure to ZVAD-fmk. ZVAD-fmk is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013).

The peptide-ZVAD-fmk conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidney. The subject is a human or animal and has acute kidney injury. Upon administration and homing of peptide-ZVAD-fmk conjugates, the surgical intervention, surgery for acute kidney injury condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 42 Peptide-S-methylisothiourea Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 4 this disclosure to S-methylisothiourea. S-methylisothiourea is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013).

The peptide-S-methylisothiourea conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidney. The subject is a human or animal and has kidney iron overload, renal ischemia reperfusion injury, or acute kidney injury. Upon administration and homing of peptide-S-methylisothiourea conjugates, the kidney iron overload, renal ischemia reperfusion injury, or acute kidney injury condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 43 Peptide-P188 Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 41 this disclosure to P188. P188 is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013).

The peptide-P188 conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidney. The subject is a human or animal and has kidney infection or sepsis. Upon administration and homing of peptide-P188 conjugates, the kidney infection or sepsis condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 44 Peptide-MIP-3α Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 5 to MIP-3α. MIP-3α is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013). From one to eight peptides are linked to MIP-3α. Alternatively the peptide-active agent of this Example is expressed as a fusion protein

The peptide-MIP-3α conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to the kidney. The subject is a human or animal and has kidney injury, repair and regeneration of kidney. Upon administration and homing of peptide-MIP-3α conjugates, the kidney injury, repair and regeneration of kidney condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 45 Peptide-BMP-7 Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 132 to BMP-7. BMP-7 is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) edition, 2013). From one to eight peptides are linked to BMP-7. Alternatively the peptide-active agent of this Example can be expressed as a fusion protein.

The peptide-BMP-7 conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidney. The subject is a human or animal and has acute kidney injury or chronic kidney disease. Upon administration and homing of peptide-BMP-7 conjugates, the kidney condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 46 Peptide-Icariin Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 6 to icariin. Icariin is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., Edition, 2013).

The peptide-icariin conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidney. The subject is a human or animal and has acute kidney injury or chronic kidney disease. Upon administration and homing of peptide-icariin conjugates, the kidney condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, or SEQ ID NO: 5, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 47 Peptide-Captopril Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 132 to captopril. Captopril is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013).

The peptide-captopril conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidneys. The subject is a human or animal and has diabetic nephropathy. Upon administration and homing of peptide-captopril conjugates, the diabetic nephropathy condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 48 Peptide-Tofacitinib Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 33 to tofacitinib. Tofacitinib is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013).

The peptide-tofacitinib conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to the kidney. The subject is a human or animal and has undergone kidney transplant. Upon administration and homing of peptide-tofacitinib conjugates, immune response to or rejection of the transplanted kidney is reduced or eliminated, and any damage or injury caused by the kidney transplant is alleviated and regeneration of tissues and/or host acceptance of the transplant is promoted.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 49 Peptide-Dimethyl fumarate Conjugates

This example describes conjugation of a peptide of SEQ ID NO: 4 to dimethyl fumarate. Dimethyl fumarate is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) Edition, 2013). Alternatively, peptide-dimethyl fumarate conjugates can be synthesized by Michael addition of a thiol (on the peptide of linker) to dimethyl fumarate as described by Schmidt et al. (Bioorg Med Chem. 2007 Jan. 1; 15(1):333-42. Epub 2006 Sep. 29.).

The peptide-dimethyl fumarate conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidneys. The subject is a human or animal and has kidney fibrosis. Upon administration and homing of peptide-dimethyl fumarate conjugates, the kidney fibrosis condition is alleviated.

The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 50 Intra-Kidney Administration of Peptides and Peptide Conjugates

This example illustrates direct introduction into kidney by administration of peptides or peptide conjugates of this disclosure. A peptide of this disclosure is expressed recombinantly or chemically synthesized. In some cases, the peptide is subsequently conjugated to a detectable agent or an active agent. The peptide or peptide conjugate is administered to a subject in need thereof via administration by injection or placement directly into the kidney. The kidney is penetrated by the peptide or peptide conjugate due to the small size of the peptide or peptide conjugate, and due to binding of kidney components by the peptide or peptide conjugate. The peptide or peptide conjugate is bound to or retained by the kidney and the residence time in the kidney is longer due to this binding. Optionally, the injected material is aggregated, is crystallized, or complexes are formed, further extending the depot effect and contributing to longer residence time.

The peptide can be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 51 Treatment of Gout

This example describes a method for treating gout using peptides of the present disclosure. This method is used as a treatment for acute and/or chronic symptoms associated with gout. A peptide of the present disclosure is expressed and administered in a pharmaceutical composition to a patient as a therapeutic for gout. A peptide of the disclosure is recombinantly or chemically synthesized and then is used directly or conjugated to pegloticase to treat a kidney disorder. A peptide of the disclosure is recombinantly or chemically synthesized and then is used directly or conjugated to probenecid to treat a kidney disorder. The peptide is administered in a pharmaceutical composition to a patient and the peptide is targeted to the kidney affected by gout. One or more peptides are administered to a human or animal subcutaneously, intravenously, or orally, or is injected directly into the kidney.

The peptide can be a peptide of SEQ ID NO: 41. The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 52 Treatment or Management of Pain

This example describes a method for treating or managing pain associated with a kidney injury or disorder. This method is used as a treatment for acute and/or chronic symptoms associated with a kidney injury or disorder. A peptide of the disclosure is expressed and administered in a pharmaceutical composition to a patient as a therapeutic for pain as a result of injury or other kidney condition as described herein. The peptide of the present disclosure inhibits ion channels, such as Nav 1.7. The peptide is expressed recombinantly or chemically synthesized, wherein the peptide selected from SEQ ID NO: 5 or SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Alternatively, the peptides of SEQ ID NO: 5 or SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570 are mutated to maintain the kidney homing function, but to add or increase ion channel inhibition, such as to Nav 1.7. Following expression or synthesis, the peptide is used directly or conjugated to a narcotic (e.g. oxycodone), a non-narcotic analgesic, a counter-irritant (capsaicin), or a pain receptor channel inhibitor (such as the TRPV4 inhibitor GSK2193874). Following administration of the peptide, the peptide targets to the kidney affected by pain. One or more peptides are administered to a human or animal subcutaneously, intravenously, or orally, or is injected directly into the kidney.

The peptide can be a peptide of SEQ ID NO: 5. The peptide can also be a peptide of SEQ ID NO: 5 or SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 53 Treatment or Management of Pain with Peptides Only

This example describes a method for treating or managing pain associated with a kidney injury or disorder. This method is used as a treatment for acute and/or chronic symptoms associated with a kidney injury or disorder. A peptide of the disclosure is expressed and administered in a pharmaceutical composition to a patient as a therapeutic for pain as a result of injury or other kidney condition as described herein. The peptide of the present disclosure inhibits ion channels, such as Nav 1.7. The peptide is expressed recombinantly or chemically synthesized, wherein the peptide selected from SEQ ID NO: 6 or SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, or SEQ ID NO: 5, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Alternatively, the peptides of SEQ ID NO: 6 or SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, or SEQ ID NO: 5, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570 are mutated to maintain the kidney homing function, but to add or increase ion channel inhibition, such as to Nav 1.7. Following expression or synthesis, the peptide is used directly. Following administration of the peptide, the peptide targets to the kidney affected by pain. One or more peptides are administered to a human or animal subcutaneously, intravenously, or orally, or is injected directly into a kidney.

The peptide can be a peptide of SEQ ID NO: 6. The peptide can also be a peptide of SEQ ID NO: 6, SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, or SEQ ID NO: 5, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570.

Example 54 Treatment of Renal Cell Carcinoma

This example illustrates treatment of renal cell carcinoma using peptides of the present disclosure. A peptide of the present disclosure is recombinantly expressed or chemically synthesized and are used directly, after radiolabeling, or after conjugation to a fluorophore or therapeutic compound, such as dasatinib. The peptide or peptide conjugate is administered in a pharmaceutical composition to a subject as a therapeutic for renal cell carcinoma. One or more peptides or peptide conjugates of the present disclosure are administered to a subject. A subject can be a human or an animal. The pharmaceutical composition is administered subcutaneously, intravenously, orally, or injected directly into the kidney. The peptides or peptide conjugates target kidney affected by renal cell carcinoma.

The peptide can be a peptide of SEQ ID NO: 33. The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 55 Treatment of Transitional Cell Carcinoma

This example illustrates treatment of transitional cell carcinoma using peptides of the present disclosure. A peptide of the present disclosure is recombinantly expressed or chemically synthesized and are used directly, after radiolabeling, or after conjugation to a fluorophore or therapeutic compound, such as dasatinib. The peptide or peptide conjugate is administered in a pharmaceutical composition to a subject as a therapeutic for transitional cell carcinoma. One or more peptides or peptide conjugates of the present disclosure are administered to a subject. A subject can be a human or an animal. The pharmaceutical composition is administered subcutaneously, intravenously, orally, or injected directly into the kidney. The peptides or peptide conjugates target kidney affected by transitional cell carcinoma.

The peptide can be a peptide of SEQ ID NO: 33. The peptide can also be a peptide of SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 56 Treatment for Rapid Pain Relief

This example illustrates rapid pain relief in patients treated for kidney pain with the peptides or peptide conjugates of this disclosure. A peptide of this disclosure is expressed recombinantly or chemically synthesized, and then the N-terminus of the peptide is conjugated to an active agent via an NHS ester to produce a peptide-active agent conjugate. In some aspects, the active agent such as a kidney therapeutic from TABLE 5 or TABLE 6. In some cases, the peptide alone is administered to the subject.

The peptide or peptide-active agent conjugate is administered to a subject in need thereof. The subject is a human or non-human animal. The subject in need thereof has kidney pain. The peptide or peptide conjugate is delivered via intravenous administration. Upon administration, the peptide or peptide conjugate rapidly homes to kidney. Rapid pain relief within five minutes to an hour is experienced by the subject, and pain relief can last as long as over 3 hours.

The peptide can be a peptide of SEQ ID NO: 132. The peptide can also be a peptide of SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 57 Treatment for Lupus Nephritis

This example illustrates treatment of lupus nephritis using peptides or peptide conjugates of this disclosure. A peptide of the present disclosure is recombinantly expressed or chemically synthesized and are used directly, after radiolabeling, or after conjugation to a fluorophore or therapeutic compound, such as abatacept or BIIB023.

The peptide or peptide conjugate is administered in a pharmaceutical composition to a subject as a therapeutic for lupus nephritis. The peptide is selected from any one of the peptides of SEQ ID NO: 33 or SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. One or more peptides or peptide conjugates of the present disclosure are administered to a subject. A subject can be a human or an animal. The pharmaceutical composition is administered subcutaneously, intravenously, orally, or injected directly. The peptides or peptide conjugates target kidney affected by lupus nephritis.

The peptide can be a peptide of SEQ ID NO: 33. The peptide can also be a peptide of SEQ ID NO: SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 58 Treatment for Acute Kidney Injury (AKI)

This example illustrates treatment of acute kidney injury (AKI) using peptides or peptide conjugates of this disclosure. A peptide of the present disclosure is recombinantly expressed or chemically synthesized and are used directly, after radiolabeling, or after conjugation to a fluorophore or therapeutic compound, such as such as a kidney therapeutic from TABLE 5 or TABLE 6.

The peptide or peptide conjugate is administered in a pharmaceutical composition to a subject as a therapeutic for acute kidney injury (AKI). The peptide is selected from any one of the peptides of SEQ ID NO: 132 or SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. One or more peptides or peptide conjugates of the present disclosure are administered to a subject. A subject can be a human or an animal. The pharmaceutical composition is administered subcutaneously, intravenously, orally, or injected directly into the kidney. The peptides or peptide conjugates target kidney affected by acute kidney injury (AKI).

The peptide can be a peptide of SEQ ID NO: 132. The peptide can also be a peptide of SEQ ID NO: SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 59 Treatment for Chronic Kidney Disease (CKD)

This example illustrates treatment of chronic kidney disease (CKD) using peptides or peptide conjugates of this disclosure. A peptide of the present disclosure is recombinantly expressed or chemically synthesized and are used directly, after radiolabeling, or after conjugation to a fluorophore or therapeutic compound, such as a kidney therapeutic from TABLE 5 or TABLE 6.

The peptide or peptide conjugate is administered in a pharmaceutical composition to a subject as a therapeutic for chronic kidney disease (CKD). The peptide is selected from any one of the peptides of SEQ ID NO: 33 or SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. One or more peptides or peptide conjugates of the present disclosure are administered to a subject. A subject can be a human or an animal. The pharmaceutical composition is administered subcutaneously, intravenously, orally, or injected directly into the kidney. The peptides or peptide conjugates target kidney affected by chronic kidney disease (CKD).

The peptide can be a peptide of SEQ ID NO: 33. The peptide can also be a peptide of SEQ ID NO: SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 60 Treatment for Hypertensive Kidney Damage

This example illustrates treatment of hypertensive kidney damage using peptides or peptide conjugates of this disclosure. A peptide of the present disclosure is recombinantly expressed or chemically synthesized and are used directly, after radiolabeling, or after conjugation to a fluorophore or therapeutic compound, such as such as a kidney therapeutic from TABLE 5 or TABLE 6.

The peptide or peptide conjugate is administered in a pharmaceutical composition to a subject as a therapeutic for hypertensive kidney damage. The peptide can be a peptide of SEQ ID NO: 33. The peptide is selected from any one of the peptides of SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. One or more peptides or peptide conjugates of the present disclosure are administered to a subject. A subject can be a human or an animal. The pharmaceutical composition is administered subcutaneously, intravenously, orally, or injected directly into the kidney. The peptides or peptide conjugates target kidney affected by hypertensive kidney damage.

The peptide can be a peptide of SEQ ID NO: 33. The peptide can be a peptide of SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 61 Treatment for Diabetic Nephropathy

This example illustrates treatment of diabetic nephropathy using peptides or peptide conjugates of this disclosure. A peptide of the present disclosure is recombinantly expressed or chemically synthesized and are used directly, after radiolabeling, or after conjugation to a fluorophore or therapeutic compound, such as such as a kidney therapeutic from TABLE 5 or TABLE 6.

The peptide or peptide conjugate is administered in a pharmaceutical composition to a subject as a therapeutic for diabetic nephropathy. The peptide is selected from any one of the peptides of SEQ ID NO: 33 or SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. One or more peptides or peptide conjugates of the present disclosure are administered to a subject. A subject can be a human or an animal. The pharmaceutical composition is administered subcutaneously, intravenously, orally, or injected directly into the kidney. The peptides or peptide conjugates target kidney affected by diabetic nephropathy.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 62 Treatment for Renal Fibrosis

This example illustrates treatment of renal fibrosis using peptides or peptide conjugates of this disclosure. A peptide of the present disclosure is recombinantly expressed or chemically synthesized and are used directly, after radiolabeling, or after conjugation to a fluorophore or therapeutic compound, such as such as a kidney therapeutic from TABLE 5 or TABLE 6.

The peptide or peptide conjugate is administered in a pharmaceutical composition to a subject as a therapeutic for renal fibrosis. The peptide is selected from any one of the peptides of SEQ ID NO: 33 or SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. One or more peptides or peptide conjugates of the present disclosure are administered to a subject. A subject can be a human or an animal. The pharmaceutical composition is administered subcutaneously, intravenously, orally, or injected directly into the kidney. The peptides or peptide conjugates target kidney affected by renal fibrosis.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 63 Radiolabeling of Peptide

This example describes radiolabeling of peptides of this disclosure. Several peptides were radiolabeled by reductive methylation with ¹⁴C formaldehyde and sodium cyanoborohydride with standard techniques. The sequences were engineered to have the amino acids, “G” and “S” at the N terminus. See Methods in Enzymology V91:1983 p.570 and JBC 254(11):1979 p. 4359. An excess of formaldehyde was used to ensure complete methylation (dimethylation of every free amine). The labeled peptides were isolated via solid-phase extraction on Strata-X columns (Phenomenex 8B-S100-AAK), rinsed with water with 5% methanol, and recovered in methanol with 2% formic acid. Solvent was subsequently removed in a blowdown evaporator with gentle heat and a stream of nitrogen gas. The final product was verified and characterized by high performance liquid chromatography (HPLC).

Example 64 Accumulation of Peptide in Renal Tissue

This example describes accumulation of peptides of this disclosure in renal tissue. ¹⁴C-methylated peptides were intravenously dosed into mice at 30-100 nmol per mouse. After 4-24 hours in circulation, deeply anesthesized mice were euthanized by freezing in dry ice-chilled hexane. Cryosectioning was performed on a Bright-Hacker cryotome, taking 40 μm sagittal sections. Collected sections were allowed to freeze dry at −20° C. for 48-72 hours before being exposed to phosphor imager plates. Plates were exposed for 7 days then scanned on a RayTest CR-Bio35 scanner. Analysis was performed with ADA WBA analysis software.

FIGS. 3A and 3B show accumulation of ¹⁴C signal for a peptide of SEQ ID NO: 4 at two time points, 3 hours (FIG. 3A) and 24 hours (FIG. 3B). This data suggests that the peptide is interacting with the kidney, likely cells of the proximal tubule. It is anticipated that freely filtered proteins would not display a persistent signal in the kidneys as observed here.

Example 65 Engineering of a Peptide for Renal Therapy

This example describes engineering of a peptide of this disclosure for renal therapy. A selected cystine-dense (e.g., selected from a library of over 200,000 identified native cystine-dense peptides), or any one of SEQ ID NO: 33 or SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570, is used as a scaffold for a peptide-based therapeutic of the present invention. The peptide is engineered to have two functional elements: (1) homing to the specific site of intended action in the kidney (e.g., glomerulus, proximal tubule); and (2) therapeutic activity (e.g., block an ion channel, reduce inflammation). The peptide can be engineered to exhibit therapeutic activity in the presence or the absence of a conjugated therapeutic. The engineering of the peptide is accomplished by computational design that replaces native amino acids with those selected by computational software or researchers to increase binding and/or activity at the target. Alternatively, mammalian or Pichia display is used, in which many (e.g., tens or hundreds of thousands) of molecules are displayed on cell surfaces, and those with good binders are selected by flow cytometry. The leading candidates (e.g., identified by deep sequencing of flow-captured cells) are then used as the basis for further design. Iterative rounds of evolution using the above and related techniques are used to discover peptides that have both kidney targeting and therapeutic activity in the absence of a “payload” conjugate. The peptides are used in a renal therapy or renal therapeutic application of the present disclosure.

Example 66 Peptide Immunogenicity

This example illustrates the testing of the immunogenicity of a peptide. NetMHC II version 2.3 prediction software is used to identify immunogenic peptides based on a neural network alignment algorithm that predicts peptide binding to MHC Class II molecules.

The NetMHC II prediction software is utilized to determine the putative peptide binding capability to DR, DQ, and DP MHC II alleles and the strength of the interaction between peptide and MHC II molecules. Using such methods identifies the resulting immunogenicity score of select peptides. The numbers of strong versus weak peptides are tallied into each major MHC allele group (DR, DQ, and DP). Additionally, the numbers of ‘unique strong’ and ‘unique weak core’ peptides are also tallied. These data are used to predict which peptides are less likely to induce an immunogenic response in patients. For example, the stronger a peptide binds to an allele, the more likely it is to be presented in a MHC/peptide combination on an antigen presenting cell, thus triggering an immune response, and a peptide that is predicted to bind to fewer alleles is more likely to have weaker binding to given alleles and should be less immunogenic.

Example 67 Peptide-Budesonide Conjugate

This example describes conjugation of a peptide of any one of SEQ ID NO: 33 or SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570 to budesonide. Budesonide is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) edition, 2013) or by any of the methods described in the preceding EXAMPLES.

The peptide-budesonide conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidneys. The subject is a human or animal and has inflammation in the kidney tissues. Upon administration and homing of peptide-budesonide conjugates, the inflammation in the kidney tissues is alleviated.

Example 68 Peptide-Dexamethasone Conjugate

This example describes conjugation of a peptide of any one of SEQ ID NO: 33 or SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570 to dexamethasone. Dexamethasone is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) edition, 2013) or by any of the methods described in the preceding EXAMPLES.

The peptide-dexamethasone conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidneys. The subject is a human or animal and has inflammation in kidney tissues. Upon administration and homing of peptide-dexamethasone conjugates, the inflammation in kidney tissues is alleviated.

Example 69 Peptide-Triamcinalone Acetonide Conjugate

This example describes conjugation of a peptide of any one of SEQ ID NO: 33 or SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5 or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570 to triamicinalone acetonide. Triamicinalone acetonide is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) edition, 2013 or by any of the methods described in the preceding EXAMPLES.

The peptide-triamicinalone acetonide conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidneys. The subject is a human or animal and has inflammation in kidney tissues. Upon administration and homing of peptide-triamicinalone acetonide conjugates, the inflammation in kidney tissues is alleviated.

Example 70 Peptide-Desciclesonide Acetonide Conjugate

This example describes conjugation of a peptide of any one of SEQ ID NO: 33 or SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, SEQ ID NO: 6 or SEQ ID NO: 1-SEQ ID NO: 529, or SEQ ID NO: 570 to desciclesonide acetonide. Desciclesonide acetonide is readily conjugated to any peptide disclosed herein via standard chemistries such as those described in, but not limited to, Bioconjugate Techniques by Greg Hermanson (Elsevier Inc., 3^(rd) edition, 2013) or by any of the methods described in the preceding EXAMPLES.

The peptide-desciclesonide acetonide conjugates are administered to a subject in need thereof and home, target, are directed to, are retained by, accumulate in, migrate to, and/or bind to kidneys. The subject is a human or animal and has inflammation in kidney tissues. Upon administration and homing of peptide-desciclesonide acetonide conjugates, the inflammation in kidney tissues is alleviated.

Example 71 Method of Peptide Synthesis

This example describes the synthesis of any one of SEQ ID NO: 33 or SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570.

A selected peptide is made using Solid Phase Peptide Synthesis (SPPS). After release of the peptide from the solid phase, the peptide was purified prior to folding by oxidation in solution. The folded peptide was further purified by reversed-phase chromatography and lyophilized as a TFA salt. The final peptide product has a purity of greater than 90%, greater than 95%, greater than 98%, about 95-96%, and a mass in Da that is the estimated molecular mass of the selected peptide which confirms its identity as the selected peptide.

Example 72 Treatment of a Kidney Condition with a Peptide of the Disclosure

This example describes treatment of a kidney condition with peptides of this disclosure. A peptide of the disclosure (e.g., any of the peptides of SEQ ID NO: 33 or SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1 -SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570) is expressed recombinantly or chemically synthesized. The peptide is administered to a human or animal, where it binds to renal tissue and exhibits a therapeutic effect, e.g., via antioxidant or anti-inflammatory actions. For example, a peptide of the present disclosure is taken up by the proximal tubules, and gains access to and suppresses intracellular injury pathways. As another example, a peptide of the present disclosure migrates to the renal interstitium and inhibits interstitial inflammation and prevents renal fibrosis.

Example 73 Treatment of a Kidney Condition with a Peptide-Conjugate of the Disclosure

This example describes treatment of a kidney condition with a peptide-conjugation of this disclosure. A peptide of the disclosure (e.g., any of the peptides of SEQ ID NO: 33 or SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570) is expressed recombinantly or chemically synthesized. The peptide is then conjugated to a therapeutic agent, such as deferoxamine, dexamethasone, or another anti-inflammatory agent, a chemotherapeutic, or a steroid. Coupling of the therapeutic agent to the peptide targets the therapeutic agent to the kidney. One or more peptide-conjugates are administered to a human or animal. The therapeutic agent is presented in the kidney at adequate concentration to provide a therapeutic effect, such as an antioxidant, anti-inflammatory, or a chemotherapeutic effect. Optionally, the concentration of the therapeutic agent in other tissues is sufficiently low so to cause few or no undesirable side effects.

For example, a peptide of the present disclosure conjugated to dexamethasone or other potent anti-inflammatory agents is used as therapy for lupus affecting the kidney, vasculitis, Goodpasture's disease, focal segmental glomerulosclerosis, nephritic syndrome, or other renal disorders caused by inflammatory processes.

As another example, a peptide of the present disclosure is used to deliver a chemotherapeutic for treating renal cell carcinoma.

In a further example, a peptide of the present disclosure is used to deliver steroids for treating polycystic renal disease.

Example 74 Eliciting a Protective Response in the Kidney with a Peptide of the Disclosure

This peptide describes eliciting a protective response in the kidney with peptides of this disclosure. A peptide of the disclosure (e.g., any of the peptides of SEQ ID NO: 33 or SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570) is expressed recombinantly or chemically synthesized. The peptide is administered to a human or animal, where it binds to renal tissue and induces ischemic preconditioning or acquired cytoresistance in the kidney. The peptide is administered to the subject prior to an anticipated injury to the kidney, such as surgery or imaging. The injury that occurs to the kidney is reduced by the peptide. Optionally, the progression of acute kidney injury to chronic kidney disease is reduced by the protective response.

Example 75 Protecting the Kidney from Nephrotoxic Agents with a Peptide of the Disclosure

This example describes protecting the kidney from nephrotoxic agents with peptides of this disclosure. A peptide of the disclosure (e.g., any of the peptides of SEQ ID NO: 33 or SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570) is expressed recombinantly or chemically synthesized. The peptide is administered to a human or animal, where it binds to renal tissue, e.g., at megalin-cubulin binding sites. The peptide is administered to the subject prior to or currently with a nephrotoxic agent (e.g., aminoglycoside antibiotics such as gentamicin, vancomycin, and minocycline, chemotherapeutics such as cisplatin, immunoglobulins, mannitol, NSAIDs, cyclosporin, cyclophosphamide, radiocontrast dyes) in order to minimize its damaging effects, e.g., by blocking megalin-cubulin binding sites so that the nephrotoxic agent passes through the kidneys.

Example 76 Eliciting a Protective Response in the Kidney with a Peptide-Conjugate of the Disclosure

This example describes eliciting a protective response in the kidney with a peptide-conjugation of this disclosure. A peptide of the disclosure (e.g., any of the peptides of SEQ ID NO: 33 or SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570) is expressed recombinantly or chemically synthesized. The peptide is then conjugated to a renal protective agent, such as a deferoxamine, or a chelate or porphyrin complex (e.g., hemin, an EDTA-Fe complex). Coupling of the protective agent to the peptide targets the protective agent to appropriate regions of the kidney with a suitable pharmacokinetic profile. One or more peptide-conjugates are administered to a human or animal. The peptide conjugate is administered to the subject prior to an anticipated injury to the kidney, such as surgery or imaging. The renal tissue injury that occurs in the kidney is reduced by the peptide conjugate. Optionally, the progression of kidney injury to chronic kidney disease is reduced by the protective response.

For example, a peptide of the present disclosure is conjugated to hemin, which signals through the heat shock/heme reactive element pathway. Once intracellular localization is achieved, an upregulation of a set of diverse cytoprotective proteins occurs. The peptide-hemin conjugate is administered to a subject who will undergo high-risk surgeries or radiocontrast administration. The peptide-hemin conjugate is administered one day prior to the procedure in order to allow sufficient time for the upregulation of protective proteins to occur.

As another example, a peptide of the present disclosure is used to deliver iron to the kidney, either as a chelate or porphyrin complex, in order to alter gene expression profiles and induce expression of cytoprotective proteins.

Example 77 Confocal Imaging of Kidneys

This example illustrates confocal imaging of kidneys from mice administered peptides of the present disclosure. A dose of 10 nmol of AlexFluor 647 (AF647) labeled peptide was administered intravenously in mice (2 per group). Mice were euthanized 20 hours post-peptide administration and kidneys were harvested and cut into 2 mm sections. Adjacent sections were scanned on an Odyssey instrument at 54 μm resolution in the 700 nm channel or imaged on a Zeiss laser scanning microscope (LSM) 780 confocal microscope at 6× and 20× magnification.

FIG. 5 shows fluorescence of kidney sections from mice, in which each mouse received 10 nmol free fluorophore (AF647), 10 nmol SEQ ID NO: 41 conjugated to AF647, 10 nmol SEQ ID NO: 5 conjugated to AF647, or 10 nmol SEQ ID NO: 33 conjugated to AF647. Each kidney was from an independent mouse (2 mice per group).

FIG. 6 shows SEQ ID NO: 5 conjugated to AF647 and SEQ ID NO: 41 conjugated to AF647 fluorescence signal in confocal images of the kidney cortex. FIG. 6A shows fluorescence signal of SEQ ID NO: 5 conjugated to AF647 in the kidney cortex 20 hours after of administration of 10 nmol of the peptide-dye conjugate at 6x magnification. FIG. 6B shows fluorescence signal of SEQ ID NO: 5 conjugated to AF647 in the kidney cortex 20 hours after administration of 10 nmol of the peptide-dye conjugate at 20× magnification. FIG. 6C shows fluorescence signal of SEQ ID NO: 5 conjugated to AF647 in the kidney cortex 20 hours after administration of 10 nmol of the peptide-dye conjugate at 6× magnification. FIG. 6D shows fluorescence signal of SEQ ID NO: 5 conjugated to AF647 in the kidney cortex 20 hours after of administration of 10 nmol of the peptide-dye conjugate at 20× magnification.

FIG. 7 shows SEQ ID NO: 33 conjugated to AF647 fluorescence signal in confocal images of the kidney cortex. FIG. 7A shows fluorescence signal of SEQ ID NO: 33 conjugated to AF647 in the kidney cortex 20 hours after administration of 10 nmol of the peptide-dye conjugate at 6× magnification. FIG. 7B shows fluorescence signal of SEQ ID NO: 33 conjugated to AF647 in the kidney cortex 20 hours after administration of 10 nmol of the peptide-dye conjugate at 20× magnification. FIG. 7C shows fluorescence signal in the kidney cortex 20 hours after administration of 10 nmol of a lysozyme-dye conjugate at 6× magnification. FIG. 7D shows fluorescence signal in the kidney cortex 20 hours after of administration of 10 nmol of a lysozyme-dye conjugate at 20× magnification.

Therefore, FIG. 5 shows that the peptides can accumulate the conjugated dye in the cortex of the kidney, and FIG. 6 and FIG. 7 show that the peptides can accumulate the conjugate dye in the proximal tubules in the kidney, as confirmed by the positive control lysozyme which has been shown to accumulate in the proximal tubules.

Example 78 Competitive Renal Uptake Studies

This example describes competitive uptake studies of peptides of this disclosure in kidneys. Peptides of this disclosure were compared to known kidney homers (“competitors”) to assess the efficiency and strength of kidney targeting. Three competitors were tested against a peptide of SEQ ID NO: 4, and kidney uptake was quantified by fluorescence imaging of whole organs on a Spectrum IVIS imager.

FIG. 8 shows competitive renal uptake between a peptide of SEQ ID NO: 4 conjugated to AlexaFluor647 (AF647) and an unlabeled SEQ ID NO: 4 peptide 4 hours after intravenous administration of 2 nmol of SEQ ID NO: 4-AF647 co-injected with either 0 nmol of SEQ ID NO: 4 peptide (“low AF”), 10 nmol of SEQ ID NO: 4 co-injected with 2 nmol of SEQ ID NO: 4-AF647 (5:1), or 50 nmol of SEQ ID NO: 4 co-injected with 2 nmol of SEQ ID NO: 4-AF647 (25:1). Kidneys from uninjected mice were used as a negative control. Fluorescence signal in each group was quantified to determine the average radiant efficiency in the kidneys from three mice per cohort. Data are shown as mean and error bars indicate standard deviation. A p-value of 0.0081 was calculated by a T-test, and the error bars indicate standard deviation. In this experiment, the unlabeled SEQ ID NO: 4 peptide competed with the SEQ ID NO: 4-AF647 as shown by decreased fluorescence and thus, decreased accumulation of the dye labeled peptide in the kidney. This indicates that SEQ ID NO: 4 peptide uptake was specific and saturable. In contrast, FIG. 11 shows no competitive renal uptake between a peptide of SEQ ID NO: 4 conjugated to AlexaFluor647 (AF647) and unlabeled KKEEEKKEEEKKEEEKK peptide (SEQ ID NO: 571, a known renal targeting peptide; see Bioconjug Chem. 2016 Apr. 20; 27(4):1050-7) 1 hour after intravenous administration of 2 nmol of a peptide of SEQ ID NO: 4-AF647, 2 nmol of a peptide of SEQ ID NO: 4-AF647 co-injected with 100 nmol of an unlabeled peptide of SEQ ID NO: 571 (1:50), or 2 nmol of peptide of SEQ ID NO: 4-AF647 co-injected with 2000 nmol of an unlabeled peptide of SEQ ID NO: 571 (1:1000). Fluorescence signal in each group was quantified to determine the average radiant efficiency in the kidneys from three mice per cohort. Data are shown as mean and error bars indicate standard deviation. Kidney uptake of a peptide of SEQ ID NO: 4-AF647 was not dampened by SEQ ID NO: 571 peptide even at the highest ratio of competitor. The SEQ ID NO: 571 peptide failed to compete with uptake of the peptide of SEQ ID NO: 4 in kidneys. Since SEQ ID NO: 571 has been hypothesized to bind to megalin, these results potentially indicate that SEQ ID NO: 4 peptide may accumulate in the proximal tubules by a different mechanism or receptor, or may bind to megalin more strongly than SEQ ID NO: 571 peptide. FIG. 22 also shows no competitive renal uptake between a peptide of SEQ ID NO: 4 conjugated to AlexaFluor647 (AF647) and a control peptide conjugated to AF647 (control peptide-AF647), 4 hours after intravenous administration of 10 nmol of a peptide of SEQ ID NO: 4-AF647 or 10 nmol of control peptide-AF647. Fluorescence signal in each group was quantified to determine the average radiant efficiency in the kidneys from three mice per cohort. Data are shown as mean and error bars indicate standard deviation. A p-value of 0.015 was calculated by a Student's unpaired t-test. The peptide of SEQ ID NO: 4 was taken up in the kidneys to a significantly higher extent than the control peptide.

Example 79 Preclinical Testing of Competitive Inhibition of Toxic Protein Uptake by Kidneys

This example illustrates preclinical validation in mice of competitive inhibition of toxic protein uptake by kidneys. Myoglobin is a toxic protein, which can accumulate in proximal tubules via megalin-mediated endocytosis. Peptides of this disclosure, which are injected in a subject at the time of kidney myoglobin exposure, will compete for megalin-mediated uptake.

A subject is injected intramuscularly with glycerol, leading to muscle injury with myoglobin release (also referred to herein as a “myoglobin challenge”). The subject in preclinical testing is a mouse. At the time of myoglobin injection, the subject is intravenously administered a peptide of this disclosure at one of a range of doses (0.1-2 mg/mouse) or saline as a negative control. Four hours after administration, the degree of myoglobin uptake by the kidney is tested using a spectrophotometric assay. The severity of myoglobin injury is assessed by testing for siderocalin mRNA (a biomarker of this process) upregulation.

Increasing the dose of the administered peptide of this disclosure causes a reciprocal decrease in myoglobin uptake in the kidney. Treatment of a subject with peptides of this disclosure results in dose-dependent blunting of siderocalin mRNA induction. In negative control subjects, which do not receive a peptide of this disclosure, glycerol injection causes an approximate 10-fold increase in siderocalin mRNA expression.

Example 80 Preclinical Testing of Alleviation of Renal Inflammation

This example illustrates preclinical validation in a subject of the alleviation of renal inflammation following endotoxin injection. A peptide of the present disclosure is conjugated to dexamethasone as described for desciclesonide peptide conjugates in EXAMPLE 18. The subject in preclinical testing is a mouse. Mice are injected intravenously with E. Coli endotoxin at 1 mg/kg to induce renal inflammation and co-injected intravenously either with saline as a negative control or with increasing doses of a peptide of this disclosure (0.1-2 mg/mouse). Four hours post-administration, severity of renal inflammation is assessed by measuring inflammatory mediator mRNAs, such as TNFα and monocyte chemoattractant protein (MCP)-1.

Co-injection of peptides of this disclosure causes dose-dependent blunting of mRNA upregulation. In negative control subjects, which do not receive a peptide of this disclosure, endotoxin injections induces an approximate 5-fold increase in TNFα and MCP-1 mRNA expression within 4 hours of endotoxin injection.

Example 81 Peptide Detectable Agent Conjugates

This example describes the dye labeling of peptides. A peptide of the disclosure is expressed recombinantly or chemically synthesized, and then the N-terminus of the peptide is conjugated to an detectable agent via an NHS ester using DCC or EDC to produce a peptide-detectable agent conjugate. The detectable agent is the fluorophore dye is a cyanine dye, such as Cy5.5 or an Alexa fluorophore, such as Alexa647.

The peptide detectable agent conjugates are administered to a subject. The subject can be a human or a non-human animal. After administration, the peptide detectable agent conjugates home to the kidneys. The subject, or a biopsy from the subject, is imaged to visualize localization of the peptide detectable agent conjugates to the kidney. In some aspects, diagnosis of renal disorders is based on the visualization of the peptide detectable agent conjugates in kidneys after administration.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 82 Peptide Deferasirox Conjugates

This example describes conjugation of peptides of this disclosure to deferasirox, an iron chelator. A peptide of the disclosure is expressed recombinantly or chemically synthesized, and then the N-terminus of the peptide is conjugated to deferasiroxvia an NHS ester using DCC or EDC to produce a peptide-deferasiroxconjugate. Alternatively, a peptide can be conjugated to a deferasiroxby common techniques known in the art, such those described in Bioconjugate Techniques by Greg T. Hermanson (Elsevier Inc., 3^(rd) Edition, 2013).

The peptide-deferasiroxconjugates are administered to a subject. The subject can be a human or non-human animal. The subject can have a pre-existing condition, such as iron poisoning. After administration, the peptide-deferasiroxconjugates home to the kidneys. Peptide-deferasiroxconjugates are used to treat iron poising by enhancing elimination of iron in urine.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 83 Peptide Olmesartan Conjugates

This example describes conjugation of peptides of this disclosure to olmesartan. A peptide of the disclosure is expressed recombinantly or chemically synthesized, and then the N-terminus of the peptide is conjugated to olmesartanto produce a peptide-olmesartanconjugate. Optionally, a hydrolytically labile ester linkage is used in the conjugation, such that free olmesartanis released after delivery to the kidney and/or proximal tubule.

The peptide-olmesartanconjugates are administered to a subject. The subject can be a human or non-human animal. Optionally, a higher ratio of olmesartanis seen in the kidney versus in serum after administration of the peptide-olmesartanconjugate than when olmesartanis administered alone. The subject can have a pre-existing condition, such as a renal disease. After administration, the peptide-olmesartanconjugates home to the kidneys. Peptide-olmesartanconjugates is used to treat patients with renal disease.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 84 Peptide poly-L-Glutamic Acid Polymer Conjugates

This example describes conjugation of peptides of this disclosure to poly-L-glutamic acid polymers. A peptide of the disclosure is expressed recombinantly or chemically synthesized, and then the N-terminus of the peptide is conjugated to poly-L-glutamic acid polymers to produce a peptide-poly-L-glutamic acid polymer conjugate.

The peptide-poly-L-glutamic acid polymers conjugates are administered to a subject. The subject can be a human or non-human animal. The subject can have a pre-existing condition, such as kidney disease. After administration, the peptide-poly-L-glutamic acid polymers conjugates are homed to the kidneys. Peptide-poly-L-glutamic acid polymer conjugates are used to prevent loss in kidney function in a subject.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 85 Peptide Tirilazad Conjugates

This example describes conjugation of peptides of this disclosure to Tirilazad. A peptide of the disclosure is expressed recombinantly or chemically synthesized, and then the N-terminus of the peptide is conjugated to an Tirilazadto produce a peptide-Tirilazadconjugate. The Tirilazadcan be glutathione or N acetyl cysteine.

The peptide-Tirilazadconjugates are administered to a subject. The subject can be a human or non-human animal. The subject can have a pre-existing condition, such as diabetic nephropathy or post-ischemic or nephrotoxic AKI. After administration, the peptide-Tirilazadconjugates are homed to the kidneys. Peptide-Tirilazadconjugates are used to prevent loss in kidney function and protect renal function in subjects with one of the above pre-existing conditions.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 86 Prophylaxis Against Acute Kidney Injury

This example describes prophylaxis against acute kidney injury (AKI) with the peptides of the present disclosure. A peptide of this disclosure is expressed recombinantly or chemically synthesized. In some cases, the peptide is subsequently conjugated to an active agent. The peptide or peptide-active agent conjugate is administered to a subject in need thereof. The subject is a human or non-human animal. The subject in need thereof is at risk for acute kidney injury as a result of cardiovascular surgery, radiocontrast nephropathy, or cisplatin/carboplatin use. The peptide or peptide-conjugate is delivered via intravenous administration. Upon administration, the peptide or peptide conjugate rapidly targets the kidneys, and is used as prophylaxis against AKI.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 87 Treatment of Established Acute Kidney Injury

This example describes treatment of acute kidney injury (AKI) with the peptides of the present disclosure. A peptide of this disclosure is expressed recombinantly or chemically synthesized. In some cases, the peptide is subsequently conjugated to an active agent. The peptide or peptide-active agent conjugate is administered to a subject in need thereof. The subject is a human or non-human animal. The subject in need thereof has ischemic renal injury, endotoxemia-induced AKI, or established nephrotoxic AKI. The peptide or peptide-conjugate is delivered via intravenous administration. Upon administration, the peptide or peptide conjugate rapidly targets the kidneys, and is used to treat AKI.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 88 Treatment of Diabetic Nephropathy

This example describes treatment of diabetic nephropathy with the peptides of the present disclosure. A peptide of this disclosure is expressed recombinantly or chemically synthesized. In some cases, the peptide is subsequently conjugated to an active agent. The peptide or peptide-active agent conjugate is administered to a subject in need thereof. The subject is a human or non-human animal. The subject in need thereof is diagnosed with diabetic nephropathy. The peptide or peptide-conjugate is delivered via intravenous administration. Upon administration, the peptide or peptide conjugate rapidly targets the kidneys, and is used to treat diabetic nephropathy.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 89 Treatment of Hypertensive Nephrosclerosis

This example describes treatment of hypertensive nephrosclerosis with the peptides of the present disclosure. A peptide of this disclosure is expressed recombinantly or chemically synthesized. In some cases, the peptide is subsequently conjugated to an active agent. The peptide or peptide-active agent conjugate is administered to a subject in need thereof. The subject is a human or non-human animal. The subject in need thereof is has hypertensive nephrosclerosis. The peptide or peptide-conjugate is delivered via intravenous administration. Upon administration, the peptide or peptide conjugate is rapidly targeted to the kidneys, and is used to treat hypertensive nephrosclerosis.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 90 Treatment of Chronic Glomerulonephritis

This example describes treatment of chronic glomerulonephritis with the peptides of the present disclosure. A peptide of this disclosure is expressed recombinantly or chemically synthesized. In some cases, the peptide is subsequently conjugated to an active agent. The peptide or peptide-active agent conjugate is administered to a subject in need thereof. The subject is a human or non-human animal. The subject in need thereof is diagnosed with idiopathic or secondary chronic glomerulonephritis. The peptide or peptide-conjugate is delivered via intravenous administration. Upon administration, the peptide or peptide conjugate rapidly targets the kidneys, and is used to treat chronic glomerulonephritis.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 91 Treatment of Hereditary Nephropathy

This example describes treatment of hereditary nephropathy with the peptides of the present disclosure. A peptide of this disclosure is expressed recombinantly or chemically synthesized. In some cases, the peptide is subsequently conjugated to an active agent. The peptide or peptide-active agent conjugate is administered to a subject in need thereof. The subject is a human or non-human animal. The subject in need thereof is diagnosed with hereditary nephropathy, such as polycystic kidney disease or Alport's syndrome. The peptide or peptide-conjugate is delivered via intravenous administration. Upon administration, the peptide or peptide conjugate rapidly targets the kidneys, and is used to treat hereditary nephropathy.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 92 Treatment of Interstitial Nephritis

This example describes treatment of interstitial nephritis with the peptides of the present disclosure. A peptide of this disclosure is expressed recombinantly or chemically synthesized. In some cases, the peptide is subsequently conjugated to an active agent. The peptide or peptide-active agent conjugate is administered to a subject in need thereof. The subject is a human or non-human animal. The subject in need thereof is diagnosed with interstitial nephritis induced by drug use (e.g. Chinese herb induced nephropathy, NSAID induced nephropathy), multiple myeloma, or sarcoid. The peptide or peptide-conjugate is delivered via intravenous administration. Upon administration, the peptide or peptide conjugate rapidly targets the kidneys, and is used to treat interstitial nephritis.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 93 Use of Peptides in Renal Transplantation

This example describes the use of peptides of the present disclosure in renal transplantation. A peptide of this disclosure is expressed recombinantly or chemically synthesized. In some cases, the peptide is subsequently conjugated to an active agent. The peptide or peptide-active agent conjugate is administered to a subject in need thereof. The active agent is an anti-rejection drug such as prednisone, azathioprine, mycophenolate mofetil, mycophemolic acid, sirolimius, cyclosporine, or tacrolimus, and the subject is a human or non-human animal. A donor kidney is needed by the subject, which is treated with the peptide or peptide conjugate prior to transplantation. Alternatively, the subject is treated post-transplantation for delayed graft function, acute kidney rejection, or chronic rejection. For post-transplantation treatment, the peptide or peptide-conjugate is delivered via intravenous administration. Upon administration, the peptide or peptide conjugate rapidly targets the kidneys, and is used to treat post-transplantation kidney conditions.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 94 Use of Peptides to Treat Diabetes or High Blood Pressure

This example describes the use of peptides of the present disclosure to treat diabetes or high blood pressure. A peptide of this disclosure is expressed recombinantly or chemically synthesized. The peptide is administered to a subject in need thereof. Ion channels in the kidney (such as sodium channels or potassium channels) are modulated by the peptide, or the reuptake of glucose is blocked by the peptide. The subject is a human or non-human animal. The subject in need thereof is diagnosed with diabetes or high blood pressure. The peptide is delivered via intravenous administration. Upon administration, the peptide rapidly targets the kidneys and modulates sodium, potassium, or glucose transport in kidneys and is used to treat diabetes or high blood pressure.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 95 Use of Peptides to Prevent Renal Fibrosis

This example describes the use of peptides of the present disclosure to prevent renal fibrosis. A peptide of this disclosure is expressed recombinantly or chemically synthesized. The peptide is conjugated to a platelet derived growth factor (PDGF) inhibitor. The peptide-drug conjugate is administered to a subject in need thereof. The subject is a human or non-human animal. The subject in need thereof is at risk of renal fibrosis. The peptide is delivered via intravenous administration. Upon administration, the peptide rapidly targets the kidneys and prevents renal fibrosis.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 96 Oral Delivery to the Kidney

This example describes the oral delivery of peptides of the present disclosure. A peptide of this disclosure is expressed recombinantly or chemically synthesized. In some cases, the peptide is subsequently conjugated to an active agent. The peptide or peptide-active agent conjugate is administered orally to a subject in need thereof. The subject is a human or non-human animal. Upon administration, peptide or peptide-active agent rapidly targets the kidneys. Optionally, the peptide is formulated with agents to enhance oral delivery, such as permeation enhancers such as SNAC, 5-CNAC, sodium caprylate, an aromatic alcohol, EDTA, a sodium alkyl sulfate, or a citrate, or protease inhibitors. Some of the peptide is absorbed and traffics to the kidney. The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 97 Peptide Ciprofloxacin Conjugates

This example describes conjugation of peptides of this disclosure to ciprofloxacin. A peptide of the disclosure (e.g., any one of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 529) is expressed recombinantly or chemically synthesized. The peptide is linked to ciprofloxacin via an ester link to the carboxylic acid in ciprofloxacin.

The peptide-ciprofloxacin conjugates are administered to a subject. The subject can be a human or non-human animal. The subject can have a kidney infection (for example, a kidney infection that has spread from a urinary tract infection or a kidney infection that is novel) or pyelonephritis. After administration, the peptide-ciprofloxacin conjugates are homed to the kidneys. Peptide-ciprofloxacin conjugates are used to prevent loss in kidney function and protect renal function in subjects with one of the above pre-existing conditions and/or to eliminate or reduce the infection.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 98 Peptide Dapagliflozin Conjugates

This example describes conjugation of peptides of this disclosure to dapagliflozin. A peptide of the disclosure (e.g., any one of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 529) is expressed recombinantly or chemically synthesized. The peptide is linked to dapagliflozin via an ester link to the carboxylic acid in dapagliflozin.

The peptide-dapagliflozin conjugates are administered to a subject. The subject can be a human or non-human animal. The subject can have diabetes. After administration, the peptide-dapagliflozin conjugates are homed to the kidneys. Peptide-dapagliflozin conjugates are used to prevent loss in kidney function and protect renal function and/or to improve glycemic control and reduce damage to other organs due to diabetes by increasing glucose secretion in subjects with one of the above pre-existing conditions.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 99 Peptide Furosemide Conjugates

This example describes conjugation of peptides of this disclosure to furosemide. A peptide of the disclosure (e.g., any one of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 529) is expressed recombinantly or chemically synthesized. The peptide is linked to furosemide via an ester link to the carboxylic acid in furosemide.

The peptide-furosemide conjugates are administered to a subject. The subject can be a human or non-human animal. The subject can have diabetes, hypertension, chronic kidney disease, or nephrotic syndrome. After administration, the peptide-furosemide conjugates are homed to the kidneys. Peptide-furosemide conjugates increase kidney diuresis and are used to prevent loss in kidney function and protect renal function, and/or reduce hypertension and effects thereof in subjects with one of the above pre-existing conditions.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 100 Treatment of Renal Insufficiency

This example describes treatment of renal insufficiency with the peptides of the present disclosure. A peptide of this disclosure is expressed recombinantly or chemically synthesized. In some cases, the peptide is subsequently conjugated to an active agent. The peptide or peptide-active agent conjugate is administered to a subject in need thereof. The subject is a human or non-human animal. The subject in need thereof is diagnosed with renal insufficiency that may be caused by renal artery disease. The peptide or peptide-conjugate is delivered via intravenous administration. Upon administration, the peptide or peptide conjugate rapidly targets the kidneys, and is used to treat renal insufficiency.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570. Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 101 Grafting of Moieties to Enhance Peptide Binding and/or Accumulation in the Kidney

This example describes grafting of other moieties to any peptide of the present disclosure (e.g. SEQ ID NO: 33 or SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570). Another moiety is grafted to the peptide to enhance binding and/or accumulation in the kidney. Grafting can be performed in a variety of ways. A loop, or fraction of a loop, of a peptide of this disclosure is deleted and replaced with any of the moieties listed below, or a fraction thereof. Such a peptide of this disclosure is expressed recombinantly or chemically synthesized. Or, grafting is done by inserting the nucleic acid sequence of the other moiety into the vector comprising a nucleic acid sequence of a peptide of the present, which is then expressed as a fusion of the other moiety and the peptide of the present disclosure. Alternatively, the other moiety is conjugated to a recombinantly expressed or chemically synthesized peptide of this disclosure. Other moieties that are grafted or conjugated to any peptide of this disclosure include Y(KKEEE)₃K (SEQ ID NO: 624), Y(KKEE)₅K (SEQ ID NO: 625), Y(KKQQQ)₃K (SEQ ID NO: 626), Y(MARIA)₃ (SEQ ID NO: 627), (KKEEE)₃K (SEQ ID NO: 628), (KKEE)₅K (SEQ ID NO: 629), (KKQQQ)₃K (SEQ ID NO: 630), (MARIA)₃ (SEQ ID NO: 631), (APASLYN)₂ (SEQ ID NO: 632),and ANTPCGPYTHDCPCKR (SEQ ID NO: 633). (Janzer et al. Bioconjug Chem. 2016 Oct. 4, Geng et al. Bioconjug Chem. 2012 Jun. 20; 23(6):1200-10, Wischnjow et al. Bioconjug Chem. 2016 Apr. 20; 27(4):1050-7.). Any L-Tyr residue in any of the foregoing can be modified to D-Tyr, for example, for the purposes of radiolabeling.

Grafting of these other moieties to a peptide of this disclosure can confer additional targeting properties by enhancing, changing, or modifying the properties of the peptides of the present disclosure. Other moieties contain positively charged residues, which increasing binding of peptides to proximal tubule cells, to megalin (which is negatively charged), or otherwise increase retention in the kidney. Other moieties also modify the properties of the peptides of this disclosure by changing charge, changing absorption properties into the proximal tubules, or changing targeting of specific structures within the kidney.

Example 102 Peptide Torsemide Conjugates

This example describes conjugation of peptides of this disclosure to torsemide. A peptide of the disclosure (e.g., any one of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 529) is expressed recombinantly or chemically synthesized. The peptide is linked to torsemide via a cleavable or stable linker.

The peptide-torsemide conjugates are administered to a subject. The subject can be a human or non-human animal. The subject can have edema as a result of kidney disease or high blood pressure. After administration, the peptide-torsemide conjugates are homed to the kidneys. Peptide-torsemide conjugates increase kidney diuresis and are used to prevent loss in kidney function and protect renal function, and/or reduce hypertension and effects thereof in subjects with one of the above pre-existing conditions.

The peptide can be a peptide of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570 Such peptide-drug conjugates can be made using either a cleavable or stable linker as described herein (e.g., EXAMPLES 14 and 15).

Example 103 Fluorescence of Kidney Homing Peptides

This example illustrates peptide homing to kidney after administration of a peptide fluorophore conjugate. A peptide of any one of SEQ ID NO: 33, SEQ ID NO: 132, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, or SEQ ID NO: 6, or any of SEQ ID NO: 1-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, SEQ ID NO: 216-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, SEQ ID NO: 451-SEQ ID NO: 529, or SEQ ID NO: 570 is chemically conjugated to a cyanine, tricarboxocyanine or other fluorescent dye and then imaged using, for example, the methods of EXAMPLE 59.

Example 104 Peptide Resistance Under Various Conditions

This example illustrates peptide stability under various stress conditions such as high temperature, low pH, reducing agents, and proteases. To determine resistance to high temperatures, cystine-dense peptides (CDPs) are incubated at 0.5 mM in PBS at 75° C. or 100° C. for 1 h and pelleted, and the supernatant is analyzed with reversed-phase chromatography (RPC). To determine resistance to proteolytic digestion, CDPs are mixed with 50 U of porcine pepsin, in simulated gastric fluid at pH 1.0, or 50 U of porcine trypsin in PBS, incubated for 30 minutes at 37° C. and analyzed with RPC. Oxidized and reduced forms (prepared through addition 10 mM DTT) are compared. Circular Dichroism spectroscopy is used in order to measure the secondary structure of peptides with a Jasco J-720W spectropolarimeter in a cell with a 1.0-mm path length, and CDPs are diluted into 20 mM phosphate buffer, pH 7.4, at a concentration of 15-25 μM. These conditions are expected to denature or degrade conventional globular proteins and many peptides. In scoring the results, “high” resistance indicates a high amount of the peptide remains or is retained as unmodified under the given experimental conditions and “low” resistance indicates a low amount of the peptide remains or is retained unmodified under the given experimental conditions. Notably, the experimental conditions described in this example are more extreme stress conditions than many standard in vivo or physiologic conditions, in vitro conditions, conditions during manufacturing, and handling conditions. As such, even “low” resistance in this assay can indicate meaningful resistance to these stress conditions that may have applicability for a number of uses described herein.

While certain embodiments of the present disclosure have been exemplified or shown and described herein, it will be apparent to those skilled in the art that such embodiments are provided by way of example only. It is not intended that the disclosure be limited by the specific examples provided within the specification. While the disclosure has been described with reference to the aforementioned specification, the descriptions and illustrations of the embodiments herein are not meant to be construed in a limiting sense. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the disclosure. Furthermore, it shall be understood that all embodiments of the disclosure are not limited to the specific depictions, configurations or relative proportions set forth herein which depend upon a variety of conditions and variables. It should be understood that various alternatives to the embodiments of the disclosure described herein may be employed in practicing the disclosure. It is therefore contemplated that the disclosure shall also cover any such alternatives, modifications, variations or equivalents. It is intended that the following claims define the scope of the disclosure and that methods and structures within the scope of these claims and their equivalents be covered thereby. 

What is claimed:
 1. A peptide active agent conjugate, comprising: a) a peptide, wherein the peptide comprises a sequence that has at least 70% sequence identity with any one of SEQ ID NO: 236-SEQ ID NO: 276, wherein upon administration to a subject the peptide homes, targets, migrates to, accumulates in, binds to, is retained by, or is directed to a kidney of the subject, and an active agent selected from an active agent class selected from TABLE 5 or TABLE 6; b) a peptide, wherein the peptide comprises a sequence that has at least 70% sequence identity with any one of SEQ ID NO: 1-SEQ ID NO: 41, wherein upon administration to a subject the peptide homes, targets, migrates to, accumulates in, binds to, is retained by, or is directed to a kidney of the subject, and an active agent selected from TABLE 5 or TABLE 6; c) a peptide, wherein the peptide comprises a sequence that has at least 70% sequence identity with any one of SEQ ID NO: 471-SEQ ID NO: 529, wherein upon administration to a subject the peptide homes, targets, migrates to, accumulates in, binds to, is retained by, or is directed to a kidney of the subject, and an active agent selected from an active agent class selected from TABLE 5 or TABLE 6; d) a peptide, wherein the peptide comprises a sequence that has at least 70% sequence identity with any one of SEQ ID NO: 277-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 470 wherein upon administration to a subject the peptide homes, targets, migrates to, accumulates in, binds to, is retained by, or is directed to a kidney of the subject, and an active agent selected from an active agent class selected from TABLE 6; or e) a peptide, wherein the peptide comprises a sequence that has at least 70% sequence identity with any one of SEQ ID NO: 42-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, or SEQ ID NO: 216-SEQ ID NO: 235, wherein upon administration to a subject the peptide homes, targets, migrates to, accumulates in, binds to, is retained by, or is directed to a kidney of the subject, and an active agent selected from an active agent class selected from TABLE
 6. 2. The peptide active agent conjugate of claim 1, wherein the active agent is selected from TABLE
 5. 3. The peptide active agent conjugate of any one of claims 1-2, wherein the peptide active agent conjugate homes, targets, migrates to, accumulates in, binds to, is retained by, or is directed to a kidney of the subject.
 4. The peptide active agent conjugate of any one of claims 1-3, wherein the peptide homes, targets, migrates to, accumulates in, binds to, is retained by, or is directed to proximal tubules of the kidney.
 5. The peptide active agent conjugate of any one of claims 1-4, wherein the peptide comprises: a) a sequence that has at least 75%, at least 80%, at least 85%, at least 90%, or at least 95%, at least 97%, at least 99% or 100% sequence identity with any one of SEQ ID NO: 236-SEQ ID NO: 276, or a fragment thereof; b) a sequence that has at least 75%, at least 80%, at least 85%, at least 90%, or at least 95%, at least 97%, at least 99% or 100% sequence identity with any one of SEQ ID NO: 1-SEQ ID NO: 41 or a fragment thereof; c) a sequence that has at least 75%, at least 80%, at least 85%, at least 90%, or at least 95%, at least 97%, at least 99% or 100% sequence identity with any one of SEQ ID NO: 471-SEQ ID NO: 529or a fragment thereof; d) a sequence that has at least 75%, at least 80%, at least 85%, at least 90%, or at least 95%, at least 97%, at least 99% or 100% sequence identity with any one of SEQ ID NO: 277-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 470 or a fragment thereof; or e) a sequence that has at least 75%, at least 80%, at least 85%, at least 90%, or at least 95%, at least 97%, at least 99% or 100% sequence identity with any one of SEQ ID NO: 42-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, or SEQ ID NO: 216-SEQ ID NO: 235 or a fragment thereof.
 6. The peptide active agent conjugate of any one of claims 1-5, wherein the peptide comprises: a) a sequence of any one of SEQ ID NO: 236-SEQ ID NO: 276 or a fragment thereof; b) a sequence of any one of SEQ ID NO: 1-SEQ ID NO: 41 or a fragment thereof; c) a sequence of any one of SEQ ID NO: 471-SEQ ID NO: 529 or a fragment thereof; d) a sequence of any one of SEQ ID NO: 277-SEQ ID NO: 355, SEQ ID NO: 362-SEQ ID NO: 441, SEQ ID NO: 448, or SEQ ID NO: 451-SEQ ID NO: 470 or a fragment thereof; or e) a sequence of any one of SEQ ID NO: 42-SEQ ID NO: 120, SEQ ID NO: 127-SEQ ID NO: 206, SEQ ID NO: 213, or SEQ ID NO: 216-SEQ ID NO: 235 or a fragment thereof.
 7. The peptide active agent conjugate of any one of claims 1-6, wherein the peptide comprises: a) a sequence of any one of SEQ ID NO: 550-SEQ ID NO: 569 or a fragment thereof; or b) a sequence of any one of SEQ ID NO: 530-SEQ ID NO: 549 or SEQ ID NO: 570, or a fragment thereof.
 8. The peptide of any one of claims 1-7, wherein the peptide is at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 97%, 98%, 99% or 100% identical to SEQ ID NO: 135; SEQ ID NO: 42, SEQ ID NO: 45, SEQ ID NO: 217, SEQ ID NO: 48, SEQ ID NO: 132, SEQ ID NO: 54, SEQ ID NO: 231, SEQ ID NO: 43, SEQ ID NO: 130, SEQ ID NO: 44, SEQ ID NO: 219, SEQ ID NO: 131, SEQ ID NO: 33, SEQ ID NO: 4, SEQ ID NO: 41, SEQ ID NO: 5, SEQ ID NO: 6, or SEQ ID NO:
 196. 9. The peptide active agent conjugate of any one of claims 1-8, wherein the peptide is covalently conjugated to the active agent.
 10. The peptide active agent conjugate of any one of claims 1-9, wherein the peptide comprises 4 or more cysteine residues.
 11. The peptide active agent conjugate of any one of claims 1-10, wherein the peptide comprises three or more disulfide bridges formed between cysteine residues, wherein one of the disulfide bridges passes through a loop formed by two other disulfide bridges.
 12. The peptide active agent conjugate of any one of claims 1-11, wherein the peptide comprises a plurality of disulfide bridges formed between cysteine residues.
 13. The peptide active agent conjugate of any one of claims 1-12, wherein the peptide comprises a disulfide through a disulfide knot.
 14. The peptide active agent conjugate of any one of claims 1-13, wherein at least one amino acid residue of the peptide is in an L configuration or, wherein at least one amino acid residue of the peptide is in a D configuration.
 15. The peptide active agent conjugate of any one of claims 1-14, wherein the sequence comprises at least 11, at least 12, at least 13, at least 14, at least 15, at least 16, at least 17, at least 18, at least 19, at least 20, at least 21, at least 22, at least 23, at least 24, at least 25, at least 26, at least 27, at least 28, at least 29, at least 30, at least 31, at least 32, at least 33, at least 34, at least 35, at least 36, at least 37, at least 38, at least 39, at least 40, at least 41, at least 42, at least 43, at least 44, at least 45, at least 46, at least 47, at least 48, at least 49, at least 50, at least 51, at least 52, at least 53, at least 54, at least 55, at least 56, at least 57, at least 58 residues, at least 59, at least 60, at least 61, at least 62, at least 63, at least 64, at least 65, at least 66, at least 67, at least 68, at least 69, at least 70, at least 71, at least 72, at least 73, at least 74, at least 75, at least 76, at least 77, at least 78, at least 79, at least 80, or at least 81 residues.
 16. The peptide active agent conjugate of any one of claims 1-15, wherein any one or more K residues are replaced by an A or R residue or wherein any one or more A or R residues are replaced by a K residue.
 17. The peptide active agent conjugate of any one of claims 1-16, wherein any one or more M residues are replaced by any one of the I, L, or V residues.
 18. The peptide active agent conjugate of any one of claims 1-17, wherein any one or more L residues are replaced by any one of the V, I, or M residues.
 19. The peptide active agent conjugate of any one of claims 1-18, wherein any one or more I residues are replaced by any of the M, L, or V residues.
 20. The peptide active agent conjugate of any one of claims 1-19, wherein any one or more V residues are replaced by any of the M, I, or L residues.
 21. The peptide active agent conjugate of any one of claims 1-20, wherein any one or more G residues are replaced by an A residue or wherein any one or more A residues are replaced by a G residue.
 22. The peptide active agent conjugate of any one of claims 1-21, wherein any one or more S residues are replaced by a T residue or wherein any one or more T residues are replaced by for an S residue.
 23. The peptide active agent conjugate of any one of claims 1-22, wherein any one or more Q residues are replaced by an N residue or wherein any one or more N residues are replaced by a Q residue.
 24. The peptide active agent conjugate of any one of claims 1-23, wherein any one or more D residues are replaced by an E residue or wherein any one or more E residues are replaced by a D residue.
 25. The peptide active agent conjugate of any one of claims 1-24, wherein the peptide has a charge distribution comprising an acidic region and a basic region.
 26. The peptide of claim 25, wherein the acidic region is a nub.
 27. The peptide of claim 25, wherein the basic region is a patch.
 28. The peptide active agent conjugate of any one of claims 1-27, wherein the peptide comprises 5-12 basic residues.
 29. The peptide active agent conjugate of any one of claims 1-28, wherein the peptide comprises 0-5 acidic residues.
 30. The peptide active agent conjugate of any one of claims 1-29, wherein the peptide comprises 6 or more basic residues and 2 or fewer acidic residues.
 31. The peptide active agent conjugate of any one of claims 1-30, wherein the peptide comprises a 4 -19 amino acid residue fragment containing at least 2 cysteine residues, and at least 2 positively charged amino acid residues.
 32. The peptide active agent conjugate of any one of claims 1-31, wherein the peptide comprises a 20-70 amino acid residue fragment containing at least 2 cysteine residues, no more than 2 basic residues and at least 2 positively charged amino acid residues.
 33. The peptide active agent conjugate of any one of claims 1-32, wherein the peptide comprises at least 3 positively charged amino acid residues.
 34. The peptide active agent conjugate of any one of claims 32-33, wherein the positively charged amino acid residues are selected from K, R, or a combination thereof.
 35. The peptide active agent conjugate of any one of claims 1-34, wherein the peptide has a charge greater than 2, 3.5, 4.5, 5.5., 6.5, 7.5, 8.5, or 9.5 at physiological pH.
 36. The peptide active agent conjugate of any one of claims 1-35, wherein the peptide is selected from a potassium channel agonist, a potassium channel antagonist, a portion of a potassium channel, a sodium channel agonist, a sodium channel antagonist, a calcium channel agonist, a calcium channel antagonist, a hadrucalcin, a theraphotoxin, a huwentoxin, a kaliotoxin, a cobatoxin or a lectin.
 37. The peptide active agent conjugate of claim 36, wherein the lectin is SHL-Ib2.
 38. The peptide active agent conjugate of any one of claims 1-37, wherein the peptide is arranged in a multimeric structure with at least one other peptide.
 39. The peptide active agent conjugate of claim 38, wherein the multimeric structure comprises a dimer, trimer, tetramer, pentamer, hexamer, or heptamer.
 40. The peptide active agent conjugate of any one of claims 1-39, wherein at least one residue of the peptide comprises a chemical modification.
 41. The peptide active agent conjugate of claim 40, wherein the chemical modification is blocking the N-terminus of the peptide.
 42. The peptide active agent conjugate of claim 41, wherein the chemical modification is methylation, acetylation, or acylation.
 43. The peptide of claim 41, wherein the chemical modification is: methylation of one or more lysine residues or analogue thereof; methylation of the N-terminus; or methylation of one or more lysine residue or analogue thereof and methylation of the N-terminus.
 44. The peptide active agent conjugate of any one of claims 1-43, wherein the peptide is linked to an acyl adduct.
 45. The peptide active agent conjugate of any one of claims 1-44, wherein the peptide is linked to an active agent.
 46. The peptide active agent conjugate of claim 45, wherein the active agent is fused with the peptide at an N-terminus or a C-terminus of the peptide.
 47. The peptide active agent conjugate of claim 46, wherein the active agent is another peptide.
 48. The peptide active agent conjugate of claim 46, wherein the active agent is an antibody or an antibody fragment.
 49. The peptide active agent conjugate of claim 46, wherein the active agent is an Fc domain, Fab domain, scFv, or Fv fragment.
 50. The peptide active agent conjugate of any one of claims 46-49, wherein the peptide fused with an Fc domain comprises a contiguous sequence.
 51. The peptide active agent conjugate of any one of claims 46-49, wherein 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 active agents are linked to the peptide.
 52. The peptide active agent conjugate of any one of claims 46-49, wherein the peptide is linked to the active agent via a cleavable linker.
 53. The peptide active agent conjugate of any one of claims 46-52, wherein the peptide is linked to the active agent at an N-terminus, at the epsilon amine of an internal lysine residue, at an carboxylic acid of an aspartic acid or glutamic acid residue, or a C-terminus of the peptide by a linker.
 54. The peptide active agent conjugate of any one of claims 46-53 further comprising a non-natural amino acid, wherein the non-natural amino acid is an insertion, appendage, or substitution for another amino acid.
 55. The peptide active agent conjugate of claim 54, wherein the peptide is linked to the active agent at the non-natural amino acid by a linker.
 56. The peptide active agent conjugate of any one of claims 46-55, wherein the linker comprises an amide bond, an ester bond, a carbamate bond, a carbonate bond, a hydrazone bond, an oxime bond, a disulfide bond, a thioester bond, a thioether bond, a triazole, a carbon-carbon bond, or a carbon-nitrogen bond.
 57. The peptide active agent conjugate of claim 56, wherein the cleavable linker comprises a cleavage site for matrix metalloproteinases, thrombin, cathepsins, or beta-glucuronidase.
 58. The peptide active agent conjugate of any one of claims 53-57, wherein the linker is a hydrolytically labile linker.
 59. The peptide active agent conjugate of any one of claims 53-58, wherein the linker is pH sensitive, reducible, glutathione-sensitive, or protease cleavable.
 60. The peptide active agent conjugate of any one of claims 46-59, wherein the peptide is linked to the active agent via a stable linker.
 61. The peptide active agent conjugate of any one of claims 1-60, wherein the peptide is linked to a detectable agent.
 62. The peptide active agent conjugate of claim 61, wherein the detectable agent is fused with the peptide at an N-terminus or a C-terminus of the peptide.
 63. The peptide active agent conjugate any one of claims 61-62, wherein 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 detectable agents are linked to the peptide.
 64. The peptide active agent conjugate of any one of claims 61-63, wherein the peptide is linked to the detectable agent via a cleavable linker.
 65. The peptide active agent conjugate of any one of claims 61-64, wherein the peptide is linked to the detectable agent at an N-terminus, at the epsilon amine of an internal lysine residue, or a C-terminus of the peptide by a linker.
 66. The peptide active agent conjugate of any one of claims 61-65, further comprising a non-natural amino acid, wherein the non-natural amino acid is an insertion, appendage, or substitution for another amino acid.
 67. The peptide active agent conjugate of claim 66, wherein the peptide is linked to the active agent at the non-natural amino acid by a linker.
 68. The peptide active agent conjugate of any one of claims 61-67, wherein the linker comprises an amide bond, an ester bond, a carbamate bond, a hydrazone bond, an oxime bond, or a carbon-nitrogen bond.
 69. The peptide active agent conjugate of claim 68, wherein the cleavable linker comprises a cleavage site for matrix metalloproteinases, thrombin, cathepsins, or beta-glucuronidase.
 70. The peptide active agent conjugate of any one of claims 61-69, wherein the peptide is linked to the detectable agent via a stable linker.
 71. The peptide active agent conjugate of any one of claims 61-70, wherein the detectable agent is a fluorophore, a near-infrared dye, a contrast agent, a nanoparticle, a metal-containing nanoparticle, a metal chelate, an X-ray contrast agent, a PET agent, a radioisotope, or a radionuclide chelator.
 72. The peptide active agent conjugate of any one of claims 61-71, wherein the detectable agent is a fluorescent dye.
 73. The peptide active agent conjugate of any one of claims 1-72, wherein the peptide has an isoelectric point of about
 9. 74. The peptide active agent conjugate of any one of claims 1-73, wherein the peptide is SEQ ID NO: 45, SEQ ID NO: 132, SEQ ID NO: 33, SEQ ID NO: 4, is SEQ ID NO: 41, SEQ ID NO: 5, SEQ ID NO: 6, or SEQ ID NO:
 570. 75. The peptide active agent conjugate of any one of claims 1-74, wherein the peptide comprises at least 4, at least 5, at least 6, at least 7, at least 8, at least 9, at least 10, at least 11, at least 12, at least 13, at least 14, at least 15, or at least 16 cysteine residues.
 76. The peptide active agent conjugate of any one of claims 1-75, wherein at least one amino acid residue of the peptide is in an L configuration or, wherein at least one amino acid residue is in a D configuration.
 77. The peptide active agent conjugate of any one of claims 1-76, wherein the peptide comprises or is derived from the group consisting of: chlorotoxins, brazzeins, circulins, stecrisps, hanatoxins, midkines, hefutoxins, potato carboxypeptidase inhibitors, bubble proteins, attractins, α-GI, α-GID, μ-pIIIA, ω-MVIIA, ω-CVID, χ-MrIA, ρ-TIA, conantokin G, contulakin G, GsMTx4, margatoxins, shK, toxin K, chymotrypsin inhibitors (CTI), EGF epiregulin core, hainantoxins, theraphotoxins, hexatoxins, opicalcins, imperatoxins, defensins, and insectotoxins.
 78. The peptide active agent conjugate of any one of claims 1-77, wherein the peptide comprises or is derived from a human protein or peptide.
 79. The peptide active agent conjugate of any one of claims 1-78, wherein the peptide comprises an isoelectric point less than or equal to about 7.5.
 80. The peptide active agent conjugate of any one of claims 1-78, wherein the peptide comprises an isoelectric point greater than or equal to about 7.5.
 81. The peptide active agent conjugate of any one of claims 1-78, wherein the peptide comprises an isoelectric point within a range from about 3.0 to about 10.0.
 82. The peptide active agent conjugate of any one of claims 1-81, wherein the peptide comprises a non-uniform charge distribution.
 83. The peptide active agent conjugate of claim 82, wherein the peptide comprises one or more regions of concentrated positive charge.
 84. The peptide active agent conjugate of any one of claims 82-83, wherein the peptide comprises one or more regions of concentrated negative charge.
 85. The peptide active agent conjugate of any one of claims 1-84, wherein the peptide active agent conjugate comprises a mass-average molecular weight (Mw) less than or equal to 6 kDa, less than or equal to about 50 kDa, or less than or equal to about 60 kDa.
 86. The peptide active agent conjugate of any one of claims 1-85, wherein the peptide active agent conjugate comprises a mass-average molecular weight (Mw) within a range from about 0.5 kDa to about 50 kDa, or within a range from about 0.5 kDa to about 60 kDa.
 87. The peptide active agent conjugate of any one of claims 1-86, wherein the peptide is stable at pH values greater than or equal to about 7.0.
 88. The peptide active agent conjugate of any one of claims 1-87, wherein the peptide is stable at pH values less than or equal to about 5.0, less than or equal to about 3.0, or within a range from about 3.0 to about 5.0.
 89. The peptide active agent conjugate of any one of claims 1-88, wherein the peptide is stable at pH values within a range from about 5.0 to about 7.0.
 90. The peptide active agent conjugate of any one of claims 87-89, wherein the peptide being stable comprises one or more of: the peptide being capable of performing its therapeutic effect, the peptide being soluble, the peptide being resistant to protease degradation, the peptide being resistant to reduction, the peptide being resistant to pepsin degradation, the peptide being resistant to trypsin degradation, the peptide being reduction resistant, or the peptide being resistant to an elevated temperature.
 91. The peptide active agent conjugate of any one of claims 1-90, wherein upon administration to a subject, the peptide homes, targets, is directed to, accumulates in, migrates to, is retained by, or binds to renal tissue of the subject.
 92. The peptide active agent conjugate of any one of claims 1-91, wherein the peptide homes, targets, is directed to, accumulates in, migrates to, is retained by, or binds to one or more of: a cortex region, a glomerulus, a proximal tubule, a medulla region, a descending tubule, an ascending tubule, a loop of Henle, or a Bowman's capsule of the subject.
 93. The peptide active agent conjugate of any one of claims 1-92, wherein the peptide homes, targets, is directed to, accumulates in, migrates to, is retained by, or binds to a proximal tubule of the subject.
 94. The peptide active agent conjugate of claim 93, wherein the peptide homes, targets, is directed to, accumulates in, migrates to, is retained by, or binds to a cell of the proximal tubule.
 95. The peptide active agent conjugate of claim 94, wherein the peptide homes, targets, is directed to, accumulates in, migrates to, is retained by, or binds to a cell surface receptor expressed by the cell of the proximal tubule.
 96. The peptide active agent conjugate of any one of claims 1-95, wherein the peptide homes, targets, is directed to, accumulates in, migrates to, is retained by, or binds to a glomerulus of the subject.
 97. The peptide active agent conjugate of any one of claims 1-96, wherein the peptide homes, targets, is directed to, accumulates in, migrates to, is retained by, or binds to a megalin receptor, a cubulin receptor, or a combination thereof.
 98. The peptide active agent conjugate of any one of claims 1-97, wherein the peptide is internalized by a cell.
 99. The peptide active agent conjugate of claim 98, wherein the peptide is internalized by the cell via a scavenging mechanism.
 100. The peptide active agent conjugate of any one of claims 1-99, wherein the peptide exhibits a renal therapeutic effect.
 101. The peptide active agent conjugate of claim 100, wherein the renal therapeutic effect comprises a renal protective effect or renal prophylactic effect.
 102. The peptide active agent conjugate of any one of claims 1-101, wherein the peptide interacts with a renal ion channel, inhibits a protease, has antimicrobial activity, has anticancer activity, has anti-inflammatory activity, induces ischemic preconditioning or acquired cytoresistance, or produces a protective or therapeutic effect on a kidney of the subject, or a combination thereof.
 103. The peptide active agent conjugate of any one of claims 1-102, wherein the active agent comprises a renal therapeutic agent.
 104. The peptide active agent conjugate of claim 103, wherein the renal therapeutic agent accumulates in the kidney at a higher level when linked to the peptide than when not linked to the peptide.
 105. The peptide active agent conjugate of any one of claims 103-104, wherein the renal therapeutic agent comprises a renal protective agent or a renal prophylactic agent.
 106. The peptide active agent conjugate of any one of claims 103-105, wherein the renal therapeutic agent, renal protective agent, or renal prophylactic agent induces ischemic preconditioning or acquired cytoresistance in a kidney of the subject.
 107. The peptide active agent conjugate of any one of claims 100-106, wherein the active agent interacts with a renal ion channel, inhibits a protease, has antimicrobial activity, has anticancer activity, has anti-inflammatory activity, has a diuretic effect, increases glucose excretion, modulates the immune system, induces ischemic preconditioning or acquired cytoresistance, produces a protective or therapeutic effect on a kidney of the subject, reduces a clearance rate of the peptide active agent conjugate, or a combination thereof.
 108. The peptide active agent conjugate of any one of claims 1-107, further comprising a half-life modifying agent coupled to the peptide.
 109. The peptide active agent conjugate of claim 108, wherein the half-life modifying agent comprises a polymer, a polyethylene glycol (PEG), a hydroxyethyl starch, polyvinyl alcohol, a water soluble polymer, a zwitterionic water soluble polymer, a water soluble poly(amino acid), a water soluble polymer of proline, alanine and serine, a water soluble polymer containing glycine, glutamic acid, and serine, an Fc region, a fatty acid, palmitic acid, or a molecule that binds to albumin.
 110. The peptide active agent conjugate of any one of claims 1-109, wherein administration of the peptide active agent conjugate to a patient mediates inflammation, cell death, fibrosis, or any combination thereof in the kidney.
 111. The peptide active agent conjugate of any one of claims 1-110, wherein the peptide active agent complex is expressed as a fusion protein.
 112. The peptide active agent conjugate of any one of claims 102-111, wherein the renal ion channel is a calcium channel, a magnesium channel, a chlorine channel, a hydrogen channel, a potassium channel, a sodium channel, NKCC2, ROMK, ClC-Kb, ClC-Ka, NCCT, TRPM6, TRPM7, Kv1.1, Kir4.1, ROMK1, Maxi-K, ENaC, PC1, PC2, and CLC-5, or any combination thereof.
 113. A pharmaceutical composition comprising the peptide active agent conjugate of any one of claims 1-112 or a salt thereof, and a pharmaceutically acceptable carrier.
 114. The pharmaceutical composition of claim 113, wherein the pharmaceutical peptide active agent conjugate is formulated for administration to a subject.
 115. The pharmaceutical composition of any one of claims 113-114, wherein the pharmaceutical composition is formulated for inhalation, intranasal administration, oral administration, topical administration, parenteral administration, intravenous administration, subcutaneous administration, intra-articular administration, intramuscular administration, intraperitoneal administration, dermal administration, transdermal administration, or a combination thereof.
 116. A method of treating a condition in a subject in need thereof, the method comprising: administering to the subject the peptide comprising a peptide active agent conjugate of any one of claims 1-112 or a pharmaceutical peptide active agent conjugate of any one of claims 113-115.
 117. The method of claim 115, wherein the peptide active agent conjugate is administered by inhalation, intranasally, orally, topically, parenterally, intravenously, subcutaneously, intra-articularly, intramuscularly administration, intraperitoneally, dermally, transdermally, or a combination thereof.
 118. The method of any one of claims 116-117, wherein the peptide active agent conjugate homes, targets, or migrates to a kidney of the subject following administration.
 119. The method of any one of claims 116-118, wherein the condition is associated with a function of a kidney.
 120. The method of any one of claims 116-119, wherein the peptide active agent conjugate or pharmaceutical peptide active agent conjugate homes, targets, or migrates to renal tissue of the subject following administration.
 121. The method of any one of claims 116-120, wherein the condition is associated with a function of a kidney of the subject.
 122. The method of any one of claims 116-121, wherein the condition is selected from the group consisting of: acute kidney diseases and disorders (AKD), acute kidney injury, acute and rapidly progressive glomerulonephritis, acute presentations of nephrotic syndrome, acute pyelonephritis, acute renal failure, idiopathic chronic glomerulonephritis, secondary chronic glomerulonephritis, chronic heart failure, chronic interstitial nephritis, chronic kidney disease (CKD), chronic liver disease, chronic pyelonephritis, diabetes, diabetic kidney disease, fibrosis, focal sclerosis, focal segmental glomerulosclerosis, Goodpasture's disease, diabetic nephropathy, hereditary nephropathy, interstitial nephropathy, hypertensive nephrosclerosis, IgG4-related renal disease, interstitial inflammation, lupus nephritis, nephritic syndrome, partial obstruction of the urinary tract, polycystic kidney disease, progressive renal disease, renal cell carcinoma, clear cell renal cell carcinoma, papillary renal cell carincoma, chromophobe renal cell carinoma, kidney cancer, transitional cell carcinoma, nephroblastoma, renal sarcoma, renal adenoma, oncocytoma, angiomyolipoma, renal fibrosis, kidney stones, hypertension, hypotension, disorders of sodium, water, acid-base, potassium, calcium, magnesium, or phosphate balance, infections, urinary tract infections, kidney failure, hematuria, renal cysts, uremia, shock, uretal obstruction, proteinuria, Fanconi's syndrome, Bartter's syndrome, chronic renal insufficiency, renal fibrosis, graft versus host disease after renal tranplant, organ transplant rejection, and vasculitis.
 123. The method of any one of claims 116-122, wherein the condition is lupus nephritis, acute kidney injury (AKI), chronic kidney disease (CKD), hypertensive kidney damage, diabetic nephropathy, or renal fibrosis.
 124. A method of imaging an organ or body region of a subject, the method comprising: administering to the subject peptide active agent conjugate of any one of claims 61-112 or a pharmaceutical peptide active agent conjugate of any one of claims 113-115; and imaging the subject.
 125. The method of claim 124, wherein further comprising detecting a cancer or diseased region, tissue, structure or cell.
 126. The method of any one of claims 124-125, further comprising performing surgery on the subject.
 127. The method of any one of claims 124-125, further comprising treating the cancer.
 128. The method of any one of claims 124-127, wherein the surgery comprises removing the cancer or the diseased region, tissue, structure or cell of the subject.
 129. The method of claim 128, further comprising imaging the cancer or diseased region, tissue, structure, or cell of the subject after surgical removal.
 130. A method of protecting a kidney of a subject from injury, the method comprising: administering to the subject the peptide active agent conjugate of any one of claims 1-112 or the pharmaceutical peptide active agent conjugate of any one of claims 113-115.
 131. The method of claim 130, wherein the peptide active agent conjugate is administered by inhalation, intranasally, orally, topically, intravenously, subcutaneously, intramuscularly administration, intraperitoneally, or a combination thereof.
 132. The method of any one of claims 130-131, further comprising inducing ischemic preconditioning or acquired cytoresistance in the kidney of the subject.
 133. The method of any one of claims 130-132, wherein the injury is associated with one or more of: surgery, radiocontrast imaging, radiocontrast nephropathy, cardiovascular surgery, cardiopulmonary bypass, extracorporeal membrane oxygenation (ECMO), balloon angioplasty, induced cardiac or cerebral ischemic-reperfusion injury, organ transplantation, kidney transplantation, sepsis, shock, low blood pressure, high blood pressure, kidney hypoperfusion, chemotherapy, drug administration, nephrotoxic drug administration, blunt force trauma, puncture, poison, or smoking.
 134. The method of any one of claims 130-133, wherein the peptide active agent conjugate or pharmaceutical peptide active agent conjugate is administered at least 1 hour, at least 2 hours, at least 3 hours, at least 4 hours, at least 5 hours, at least 6 hours, at least 7 hours, at least 8 hours, at least 9 hours, at least 10 hours, at least 11 hours, at least 12 hours, at least 13 hours, at least 14 hours, at least 15 hours, at least 16 hours, at least 17 hours, at least 18 hours, at least 19 hours, at least 20 hours, at least 21 hours, at least 22 hours, at least 23 hours, at least 24 hours, at least 36 hours, at least 48 hours, at least 60 hours, at least 72 hours, or at least 96 hours prior to a predicted occurrence of the injury.
 135. The method of any one of claims 130-134, wherein the peptide active agent conjugate or pharmaceutical peptide active agent conjugate is administered once per day, week, or month, or once per two weeks, two months, or three months.
 136. The method of any one of claims 130-135, wherein the peptide active agent conjugate or pharmaceutical peptide active agent conjugate is administered at least 1 hour, at least 2 hours, at least 3 hours, at least 4 hours, at least 5 hours, at least 6 hours, at least 7 hours, at least 8 hours, at least 9 hours, at least 10 hours, at least 11 hours, at least 12 hours, at least 13 hours, at least 14 hours, at least 15 hours, at least 16 hours, at least 17 hours, at least 18 hours, at least 19 hours, at least 20 hours, at least 21 hours, at least 22 hours, at least 23 hours, at least 24 hours, at least 36 hours, at least 48 hours, at least 60 hours, at least 72 hours, or at least 96 hours after an occurrence of the injury.
 137. The method of any one of claims 130-136, further comprising performing a medical procedure on the subject.
 138. The method of claim 137, wherein the medical procedure comprises one or more of: surgery, radiocontrast imaging, cardiopulmonary bypass, balloon angioplasty, induced cardiac or cerebral ischemic-reperfusion injury, organ transplantation, chemotherapy, drug administration, or nephrotoxic drug administration.
 139. The method of any one of claims 137-138, wherein the peptide active agent conjugate or the pharmaceutical peptide active agent conjugate is administered at least 1 hour, at least 2 hours, at least 3 hours, at least 4 hours, at least 5 hours, at least 6 hours, at least 7 hours, at least 8 hours, at least 9 hours, at least 10 hours, at least 11 hours, at least 12 hours, at least 13 hours, at least 14 hours, at least 15 hours, at least 16 hours, at least 17 hours, at least 18 hours, at least 19 hours, at least 20 hours, at least 21 hours, at least 22 hours, at least 23 hours, at least 24 hours, at least 36 hours, at least 48 hours, at least 60 hours, at least 72 hours, or at least 96 hours prior to performing the medical procedure.
 140. The method of any one of claims 137-139, wherein the peptide active agent conjugate or the pharmaceutical peptide active agent conjugate is administered at least 1 hour, at least 2 hours, at least 3 hours, at least 4 hours, at least 5 hours, at least 6 hours, at least 7 hours, at least 8 hours, at least 9 hours, at least 10 hours, at least 11 hours, at least 12 hours, at least 13 hours, at least 14 hours, at least 15 hours, at least 16 hours, at least 17 hours, at least 18 hours, at least 19 hours, at least 20 hours, at least 21 hours, at least 22 hours, at least 23 hours, at least 24 hours, at least 36 hours, at least 48 hours, at least 60 hours, at least 72 hours, or at least 96 hours after performing the medical procedure. 